EUROCHIP-2 European Public Health Action on Cervical Cancer Screening GRELL 2006 - Palma de Majorca Public Health Program EUROPEAN COMMISSION: HEALTH &

EUROCHIP-2 EUROCHIP-2 European Public Health Action European Public Health Action on Cervical Cancer Screening on Cervical Cancer Screening

GRELL 2006 - Palma de Majorca GRELL 2006 - Palma de Majorca

Public Health ProgramEUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE - GENERAL

www.tumori.net/eurochip

Paolo BailiUnità di Epidemiologia Descrittiva e Programmazione Sanitaria

Istituto Nazionale per lo Studio e la Cura dei Tumori

INDICATOR AINDICATOR BINDICATOR C...INDICATOR Z

INDICATOR AINDICATOR BINDICATOR C...INDICATOR Z

EUROCHIP-2 DISCUSSION PLANEUROCHIP-2 DISCUSSION PLAN

COUNTRY 1 COUNTRY 2 COUNTRY 3 COUNTRY 30

ACTION 1

ACTION 2

ACTION 3

ACTION 3

ACTION 4

ACTION 4

ACTION 5

ACTION 6

ACTION 6

EUROPEAN PUBLIC HEALTH ACTION –

early diagnosis

Cervical screening

EUROPEAN PUBLIC HEALTH ACTION –

care & treatment

Pilot studies

EUROPEAN PUBLIC HEALTH ACTION -

prevention

Dietary prevention

EU CANCER PLAN

EDUCATIONAL ACTIVITY

Uterus cancers

• ICD 180: Cervical cancer

• ICD 182: Corpus uteri cancer

• ICD 179: Uterus cancers, not specified

• On the basis of overall national death certificates, it is not possible to analyze mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified

• To estimate cervical cancer mortality we used death rates for uterine cancers (ICD 179, 180, 182) in women aged 20-44, since most deaths from uterine cancer below the age of 45 years arise from the cervix

Source: Levi et al. European Journal of Cancer 36 (2000); 2266-2271

UTERUS CANCER STANDARDIZED MORTALITY RATEAGE: 20 – 44 (IN THESE AGES MOSTLY CERVICAL CANCER)

European standard per 100,000

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UTERUS CANCER (age 20-44) AVOIDABLE DEATHS. 2000

Expected avoidable deaths using following references:

Norway Finland Italy

Bulgaria 75 85 90

Latvia 20 25 25

Lithuania 50 55 55

Romania 370 410 415

TOTAL 515 575 585

+ EST, HUN, POL, CZE, SLO, SVK 810 980 1020

- Analyze the European guidelines to implement/promote/reconstruct cervical cancer screening in countries with increasing mortality trends

- Describe the opportunistic/programmed cervical cancer screening in those countries at present time

- Find difficulties and problems with specific assessment studies in these Eastern European countries

- Connect all the previous points with other European networks (EUNICE, European Cancer Screening networks)

EUROCHIP-2 ACTIVITY:TO ORGANISE A TASK FORCE ON

CERVICAL CANCER SCREENING EMERGENCY

MILESTONES

For countries without programs:For countries without programs:ASSESSMENT STUDIESASSESSMENT STUDIES

• Understand how servicesservices for cervical cancer screening and treatment currently are, or could potentially be, organized and delivered

• Identify the key organizationskey organizations involved in delivering these services, including potential leaders, coordinators, or area supervisors

• Define the level of available resourceslevel of available resources and assess how services could be financed

• Document the systemsystem for requesting and purchasing equipment and supplies, and for improving infrastructure

ASSESSMENT PHASES: ASSESSMENT PHASES: COLLECTION OF INFO ONCOLLECTION OF INFO ON

• Use of Policies, Guidelines, and Norms

• Program Management Issues

• Health Services

• Information and Education Activities

• Community Perspectives

• Laboratory

• Information Systems

ROMANIA

ROMANIA

Screening prices Screening prices VS VS

treatment pricestreatment prices• In Bulgaria the mean value of programme screening for 1

person is around 5 €

• Target population: 1.8 million (age 25-60)

• Screening interval: 3 years

• 5 € * 0.6 million = 3 million € per year

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BULGARIA

BULGARIA

Cervical cancerstages

Number of cases in Bulgaria (2001)

Prices according to EU data(Andrae Bengt - 2004)

Per item Total

St. III – IV 347 30 000 € 10 410 000 €

St. I – II 670 9 000 € 6 030 000 €

CIS 275 300 € 83 500 €

Total 1292 - 16 522 500 €

BULGARIAN BULGARIAN ESTIMATESESTIMATES

LATVIA

LATVIA CURRENT SITUATIONCURRENT SITUATION

I. Viberga - Latvia (2006)

• Prevention examination program (12.2004):

– Age 20-35: PAP smear has to be done one time per year initially and, if the results of examination are without the pathological findings, every 3 years

– Age 35-70: PAP smear has to be done one time per year• Health care reform aims at driving health care to GPs• BUT: 76% of women felt that they could not trust their GP to

perform a PAP Smear (Source: Survey Reproductive health of the population)

• ORGANIZATION OF A GROUP OF PRESSURE

• PRACTICAL PROPOSAL TO DEVELOP A SCREENING PROGRAM

LITHUANIA

LITHUANIA FIRST RESULTS OF THE NEW ACTIVATEDFIRST RESULTS OF THE NEW ACTIVATED

CERVICAL SCREENING PROGRAMCERVICAL SCREENING PROGRAM

CANCERS IN SITUCANCERS IN SITU

J. Kurtinaitis - Lithuania (2006)

EUROCHIP-2 will help the EUROCHIP-2 will help the centralization of the invitation systemcentralization of the invitation system

ESTONIA

ESTONIA PROBLEMS OF THE ORGANISED PROBLEMS OF THE ORGANISED SCREENING PROGRAMSCREENING PROGRAM

P. Veerus - Estonia (2006)

• Low participation: Only 21.7% of the 12,960 invited women attended the screening

• No funds for screening registry

• No invitation of women without insurance (~5% of population)

• To use experience from other countries to produce successful campaigns

• Group of pressure for invitation of women without insurance

• Money for starting the organization of screening registry

- To create relations with groups of pressure with national health ministries and with European Parliament

- To share information with other networks

- For countries without cervical screening programs: to study specific problems for implementation of screening programs and to find solutions to these problems

- For countries with cervical screening programs: to help specific activities that at the moment are not subsidize (ex: screening registry, centralisation of the invitation system)

EUROCHIP-2 TASK FORCE ON CERVICAL CANCER SCREENING EMERGENCY

AIMS