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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