1 cervical cancer screening problems and barriers in latvia ilze viberga md, phd ludmila engele md,...
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Cervical cancer screening problems and barriers in Latvia
Ilze Viberga MD, PhD
Ludmila Engele MD, PhD
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Cervical cancer prevalence in 1990-2005
0
50
100
150
200
250
Cases 168 193 164 179 178 187 189 168 176 213 197 185 209 207 227 219
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
3
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005Year
Latvia
Regions
Riga
Cervical cancer prevalence in 1999 – 2005
4
0
10
20
30
40
50
60
70
80
1990 1993 1996 1999 2002 2005
I stage II stage III stage IV stage
Prevalence in according to stages of cervical cancer in 1990 – 2005
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Cervical cancer incidence and mortality
0
2
4
6
8
10
12
14
16
18
20
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year
Per
100
. 000
Incidence
Mortality
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Cervical cancer incidence per 100.000 women in 1990-2005
0,0
5,0
10,0
15,0
20,0
Cases 11,8 13,0 14,2 16,4 16,6 17,8
1990 1993 1996 1999 2002 2005
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Cervical cancer incidence in according to age in 1990 – 2005
0%10%20%30%40%50%60%70%80%90%
100%
1990 1993 1996 1999 2002 2005
20-29 30-39 40-49 50-59 60-69 70-79 >=80
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Cervical cancer mortality per 100.000 women in 1990-2005
0,0
2,0
4,0
6,0
8,0
10,0
12,0
1990 1993 1996 1999 2002 2005
9
Cervical cancer incidence and mortality in age groups in 2005
0
5
10
15
20
25
30
35
40
25 -29
30 -34
35 -39
40 -44
45 -49
50 -54
55 -59
60 -64
65 -69
70 -74
75 -79
80 -84
> 85
Year
Per
100
.000
Incidence
Mortality
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Cervical cancer in Latvia
Year
Primary diagnose(per 100.000 population)
Diagnosed III+IV stage, %
First year mortality,
%
1996 14,4
2001 14,3 46,9% 29,0%
2002 16,5 46,6% 24,6%
2003 16,0 43,5% 21,8%
200418,4 48,6% 21,3%
(!)
2005 17,4 42,9% 30,3% (!)
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Cervical cancer five years life expectancy /survival– all stages
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005Year
Per
cent
age
12
Cervical cancer five years life expectancy – early and late stages
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005Year
Per
cen
tag
e
Cervical cancer Istage
Cervical cancer III-IVstage
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005
Year
Per
cen
tag
e
I stage
II stage
III stage
IV stage
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005
Year
Per
cen
tag
eI stage
II stage
III-IV stage
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Latvian female population in 2005
49,146,5
71,390,2
8678,4
80,879,1
88,888,4
79,972,4
76,178,5
65,557,6
34,912,4
6,21,2
0 20 40 60 80 100
0-4
10 14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90-94
Ag
e g
rou
p
Thousand
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Cervical cancer screening in Latvia
• The regulation of Cabinet of Ministers Nr.1046, December 19, 2006 (initially – 2005), with the supplement No.5 ”Programme of the preventive examinations” contains the Paragraph No.2.4 ”Cancer screening” (corrected in according to the proposal after the ”round-table” meeting in September, 2006):
– Taking the smear from cervix of uterus as a screening test of cervical cancer in women in age from 25 to 70 years one time per three years
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Screening results in 2005 and 2006 (two target populations: 20-34; 35-70)
cytology
2005
coverage 2005
cytology 2006
coverage 2006
Cervical canceroportunisticscreening
773799.52%(20–34)
36656(20–34)
10.04%(20–34)
8.62%(35–70)
78612(35–70)
10.42%(35–70)
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Cervical cancer screening problems and barriers in Latvia
• Informational
• Organizational
• Professional
• Financial
• Geographical
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Informational
• Population doesn’t know:– about this disease (mass media role: radio, regional
news papers, TV!)– about the meaning of screening: the test is not
treatment or a diagnostic tool if the person is a sick– the regulation and accessibility of the service
regarding to this test
• Professionals don’t know:– about the meaning of screening test – what to do exactly because no unified methodology
and guidelines of action or screening programme– how is the regulation and accessibility and payment of
the service regarding to this test (Ministry of Health very often changes terms and conditions)
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Organizational
• No calculations about the professional medical resources/population – geographical disproportion
• Cultural-historical situation in female heath care (Ob/Gyn)
• Private/public service disproportion (HCISA)(486/34 Ob/Gyn and 1800/1356/30 GP) – accessibility to the screening test service!!!
• No data exchange between laboratories and GP about the abnormal smear results
• No unified clinical database regarding to the abnormal smear results
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Professional• No trained nurses and midwives for the taking of smear
• No smear taking control
• No bordered competencies between GP and Ob/Gyn regarding to the abnormal smear results management
• No clinical guidelines for the management of woman with the abnormal smear findings within the screening programme
• No unified clinical-laboratory database
• No qualification and training criteria (minimal work load) for laboratory staff in the cervical screening programme
• Leishman methodology for preparation, coloring and assessment of smear (instead of Papanicolau)
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Financial
• Public/private gynecological service disproportion (historical-cultural background, geographical situation)
• Existing financial regulation does not allow to cover expenses of the taking and assessment of smear in screening programme for private gynecology and GP practice
• Majority of women have to pay themselves for the smear taking and assessment
• Accessibility to the screening programme is limited
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Geographical
• Infrastructure, logistics disproportion
(rural population)
• Limited professional medical resources
(rural regions)
• No geographical density assessment of female population to plan financial and human resources for the screening programme implementation
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Work groups
• Cabinet of Ministers (12 persons; March – August)
– To work out the coordinated model for collaboration among different sectors to implement the organized screening programme
– To realize and find solution of the existing problems and barriers for the implementation of the organized screening programme
– To promote accessibility of health care service
Ministry of Health– To realize and find solution of the existing problems and barriers
for the implementation of the organized screening programme– Practical ways of solution and implementation
Mass media and non-governmental organizations - information
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Eurochip project
• Technical report for the organized cervical cancer screening programme implementation in Latvia
• Main tasks:– Analysis and evaluation of the current situation of cervical
cancer screening in Latvia
– Defining the existing obstacles for the implementation of the organized cervical cancer screening in Latvia
– Making of the report with in-depth recommendations for a national promotion strategy of the population-based National Screening Programme of cervical cancer
• Stage of data collection
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Thank you for your attention!
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LATVIA DISCUSSION
• Problems of different lab methods