Transcript Document

Cervical cancer screening
problems and barriers in
Lithuania
Tallin April 2, 2007
Presented by Ruta Kurtinaitiene
[email protected]
Are we going to fight cervical cancer?
It’ look’s like a hurdle-race in Lithuania
Cervical cancer
Region
Incidence
Mortality
World
16.2
9
More developed countries
10.3
4
Less developed countries
19.1
17.6
11.2
9
LITHUANIA
Source: Globocan 2002
Cervical cancer in EU 2004
Malta
Finland
Spain
Italy
The Netherlands
Greece
France
United Kingdom
Sw eden
Belgium
Ireland
Germany
Luxembourg
Austria
Portugal
Slovenia
Denmark
Cyprus
Czech Republic
Slovakia
Estonia
Hungary
Latvia
Poland
Lithuania
Mortality
Incidence
0
2
4
6
8
10
Incidence. 100 000
Source: Globocan 2002
12
14
16
18
20
Cervical cancer screening in
Lithuania:
CA in situ and invasive cancer
D06
650
700
700
D06
600
517
500
500
Number of cases
Number of cases
572
600
400
274
300
200
483
483
2002
2003
504
462
400
300
200
125
100
84
100
0
0
2002
2003
2004
2005
Year
CA in situ
2006
2004
Year
2005
2006
Cervical cancer in Lithuania 2005
Breast
17%
Other
27%
Lung
4%
Skin
16%
Kidney
4%
Cervix uteri
7%
Rectum
4%
Stomach
5%
Ovary
5%
Corpus uteri
6%
Colon
5%
Almost 7% of female malignant tumors
THE EUROCHIP-2 IN
LITHUANIA
•
Organisation of the national group
•
Involvement in the Eurochip pilot studies
•
Collection of information on available data
•
Analysis of available data
•
Production of reports on cancer health planning
•
Connection with health planners and political makers in
order to promote actions
Health services in urban and
rural areas
140
Cities
120
Per 10.000 of population
100
Other urban and
rural
80
60
40
20
0
Medical doctors
Nurses
Hospital beds
Structure of consumers
expenditures
70
Urban
54,4
60
Rural
50
40
38,3
30
20
6,9
8,8
5,4
10
18,1
15,2
4,6
4,4
7,6 6,3
4,9 3,4
14,7
4,5 2,6
0
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Unemployment rate, total and by sex
2002 year: 13.8 both sexes, 14,6 male, 12,9 female.
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Cervical cancer screening in Lithuania
Skuodas
Biržai
Joniškis
Mažeikiai Akmenė
Pakruojis Pasvalys
Rokiškis
Kupiškis
Kretinga
Plungė
Nation - wide screening
started from July 1, 2004
Kelmė
Šilalė
Šilutė
Zarasai
Telšiai
Plungė
Radviliškis
Raseiniai
Anykščiai
Ukmergė
Kėdainiai
Tauragė
Molėtai
Ignalina
Švenčionys
Jonava
Jurbarkas
Širvintos
Šakiai
Kaišiadorys
Marijampolė
Vilkaviškis
Prienai
Trakai
Šalčininkai
Alytus
750 000 woman at age 30-60
are on the target with interval of 3 years
Utena
Varėna
Lazdijai
Cervical cancer screening in
Lithuania
• Distribution of funding – REIMBURSEMENT FOR THE
SERVICE (invitation, smear taking, PAP assessment)
• Invitation system – DECENTRALIZED
• PAP smear taking – DECENTRALIZED
• Reimbursement for PAP + LAB = approx 6 Eur
Program problems
Better financing – better results?
... but
 Program financing
2004 m. - 660 000 Lt (191 000 EUR)
2005 m. - 2 654 000 Lt (768 000 EUR)
2006 m. – 2 000 000 Lt (580 000 EUR)
... still no centralised invitation
system
... more than 50% committed funds
are not used
Survey to identify the
screening barriers
• Two surveys has been carried out to
identify the screening barriers in the
country.
First survey:
• Two municipalities has been selected to
test the possibilities of introduction of
centralized invitation system
– computerized
system
with
centralized
call/recall system and distribution of
invitations to the woman which does not
attended the programme
(approx. 3500
woman are on the target)
Atv. skaičius
80,0%
Didieji miestai
70,0%
Kiti miestai
Kaimas
60,0%
50,0%
40,0%
30,0%
20,0%
10,0%
0,0%
35-49
50-64
Amžius
65-74
The invitation to
join the programme
Municipality A: Invitation mailed to
the woman with information to visit
the primary health care center
Municipality B: Invitation mailed to the
woman with detailed information on
cervical cancer and the major risk factors.
The mailing was
supported by the information campaign by
volunteers
Survey to identify the
screening barriers
Next survey:
• Questionnaire on attitude on screening
programm, the visits to gynecologist,
knowledge of risk factors and HPV
Results of survey on invitations
• Respond rate in rural municipality on
mailed invitation was low (approx. 30%)
• Respond rate on distributed invitation by
volunteers was reasonable (approx. 60%,
the data is pending)
The additional information that was
provided to the woman was found
useful to increase the attendance rates
Results of survey on knowledge
• Number of woman – 1075
• Mean age – 33 years
• Questions:
– Do You know about the programme – 80%
– How frequently You are visiting gynecologist:
• one or twice a year – 34%
• never or rare – 65.4%
– When the first PAP smear should be taken
• when start the sexual life – 53%
• since 18 years – 24%
– Have You heard about HPV – 64%
– have You heard about vaccines – 59%
Low frequency of visits to gynecologist and insufficient
information on the disease from other sources does not
allow the woman to be more active on screening
Do you know about cervical
screening programme?
Age
Yes
No
Total
<30
571
(75.93%)
752
30-60
269
(92.76%)
25
(75.76%)
865
(80.47%)
180
(23.94%)
17
(5.86%)
7
(21.21%)
204
(18.98%)
>60
Total
290
33
1075
Frequency visit to gynecologist
Age
<30
30-60
>60
Total
1-2 time a
year
191
(25.39%)
162
(55.86%)
17
(51.51%)
370
(34.42%)
Never or
rare
561
(74.6%)
128
(43.79%)
15
(45.45%)
703
(65.4%)
Total
752
290
33
1075
Do you know about HPV?
Age
Yes
No
Total
<30
454
(60.37%)
209
(72.07%)
24
(72.73%)
687
(63.91%)
295
(39.23%)
75
(25.86%)
5
(15.15%)
375
(34.88%)
752
30-60
>60
Total
290
33
1075
Summary
• Despite of state support of cervical cancer
screening, the barriers in implementation of the
screening programme still exits
• The barriers are:
– System related - the lack of centralized invitation
system
– Patient related – the lack of knowledge on existing
prevention programme and risk factors
• Active actions should be take to overcome system
and patient related barriers in order to reduce
mortality rates from cervical cancer in Lithuania
Thank you