Transcript Cervical cancer: STUDY TO INCREASE ATTENDANCE RATE AT

Cervical cancer:
STUDY TO
INCREASE
ATTENDANCE RATE
AT SCREENING
NORWAY
Oslo
:
Presented by
R. Kurtinaitiene M. D., PhD
Vilnius University
ISPRA, 2012.02.27
Cervical Cancer Screening in Lithuania
Nation - wide screening
started at July 1, 2004
NORWAY
Oslo
Skuodas
Mažeikiai
Biržai
Joniškis
Akmenė
Pasvalys
Pa kruojis
Rokiškis
Kupiškis
Zarasai
Kretinga
841 000 women at age 25-60
are on the target,
with interval of 3 years
Allocation of resources
Plungė
Plungė
Telšiai
Radviliškis
Kelmė
Šilalė
Raseiniai
Šilutė
Anykščiai
Kėdainiai
Ukmergė
Utena
Molėtai
Ignalina
Švenčionys
Tauragė
Jonava
Jurbarkas
Širvintos
Šakiai
Vilkaviškis
Kaišiadorys
Marijampolė
Prienai
Trakai
Šalčininkai
Alytus
Varėna
Lazdijai
STATE PATIENT FUND
Distribution of resources REIMBURSEMENT FOR THE SERVICE
(invitation, smear taking, PAP assessment)
Invitation system
DECENTRALIZED
PAP smear taking
DECENTRALIZED
Changing patterns of cervical cancer:
- Invasive (C53) and - Ca in situ (D06)
2000-2010
700
626
500
586
570
600
484
468
505
468
533
485
462
359
400
479
448
455
393
256
300
200
100
528
508
118
60
63
80
0
2000 m. 2001 m. 2002 m. 2003 m. 2004 m. 2005 m. 2006 m. 2007 m. 2008 m. 2009 m. 2010 m.
Ca I-IV st.
Ca in situ
PROGRAMA
Source: National State Patients
funds data base
Number of invitations and Pap smear coverage during 20042009 program period
Source:National State Patients funds data base
AIMS OF THE STUDY
• To increase attendance rate for cervical cancer
screening program through personal invitations
• Statisticaly evaluate and compare screening
effectiveness in non-invited and invited women in region
with lowest invitation rate
• Disseminate the study results through politicians and
scientific society.
Number of invitations and volume Pap test during the programme
2009 period according Lithuanian regions
Vilnius
41826
Kaunas
90%
80%
65,7%
69,7%
65,0%
62,6%
67,8%
60%
50%
16703
Siauliai
17556
Panevezys
15938
State Patient's fund
40%
20%
Klaipeda
76,3%
70%
30%
33128
50 501
invitatio
ns
125151
0
42 139
invitations
23 235
invitations
26 762
invitations
17 999
invitations
10%
0%
Vilniaus TLK
Klaipėdos TLK
Panevėžio TLK
Kauno TLK
Šiaulių TLK
VLK
160 636
invitations
20000 40000 60000 80000 100000 120000 140000
Materials and methods
• City-Panevėžys
• PHCC-13 670 registered women at age 25-60
• woman who not participated in the program
since June 2004 were on the target
• 1789 the personal registered invitation letters
were sent by post (2010 December)
• Attendance rate was analyzed in the period
Jan-Jun 2011
• Information campaign on regional TV, local
newspapers, web site and radio to ask women to
participate in CC screening programme.
Survey on invitations
• Invitation mailed to the woman
with detailed information on
cervical cancer and the major
risk factors.
Results
• 487 invited women attend to screening
programm (response rate is 27.2%)
• 12 (2,5%) women were from rural area 3
(25%) of them had pathological cytology
• 14 cases (2.7 %) of pathological cytology
were detected
The volume of women who attend the
screening campaign from 2011 January-June
Cytology diagnosis
Cytological
diagnosis
WNL
LSIL
ASCUS
HSIL
Unsatisf
No of cases
%
456
2
9
3
12
93,6
0,4
1,8
0,6
2,5
W dgn
5
1
Total
487
100
ASCUS-1, LSIL-1, HSIL-1 (21%) rural area women
Results
• Comparing the results of the year 2010
(Jan-Jun), with the results of the year 2011
(Jan-Jun) we found that the number of
women attending the program has
increased almost twice (976 compared to
1414)
Attendance rate 2011 Jan-Jun
350
300
331
296
280
240
250
200
184
2011 Screening program
152
2011 Screening campaign
142
150
100
100
83
56
52
40
50
0
January
February
March
April
May
June
Results of action in Panevėžys municipality
(study 2011)
Summary
The pilot study using the centralized invitation
system was carried out in one the
municipalities in Lithuania. 1789 of invitations
were distributed by mail in December 2010.
Matched to the results of the year 2010, the
number of the woman attending the program
has increased almost twice (compare 978 to
1414).
Rural area women belong to the risk group of
cytological pathology
Summary
• The EUROCHIP study group suggested
that the lack of centralized invitation
system is a barrier to reaching higher
attendance rates in the program
Thank you!