Cervical cancer screening problems and barriers in

Lithuania

Presented by Ruta Kurtinaitiene ruta.kurtinaitiene@takas.lt

Tallin April Tallin April 2, 2, 20020077

It’ look’s like a hurdle-race in Lithuania

Are we going to fight cervical cancer?Are we going to fight cervical cancer?

Cervical cancer

RegionIncidence Mortality

World 16.2 9

More developed countries 10.3 4

Less developed countries 19.1 11.2

LITHUANIA 17.6 9Source: Globocan 2002

Cervical cancer in EU 2004

0 2 4 6 8 10 12 14 16 18 20

LithuaniaPoland

LatviaHungaryEstonia

SlovakiaCzech Republic

CyprusDenmark

SloveniaPortugal

AustriaLuxembourg

Germany

IrelandBelgium

SwedenUnited Kingdom

FranceGreece

The NetherlandsItaly

Spain

FinlandMalta

Incidence. 100 000

Mortality

Incidence

Source: Globocan 2002

Cervical cancer screening in Lithuania:

CA in situ and invasive cancer

483 483

572

504462

0

100

200

300

400

500

600

700

2002 2003 2004 2005 2006

Year

Num

ber o

f cas

es

D06

84125

274

517

650

0

100

200

300

400

500

600

700

2002 2003 2004 2005 2006

Year

Nu

mbe

r of

cas

es

D06

CA in situ invasive cancer

Cervical cancer in Lithuania 2005

Almost 7% of female malignant tumors

Kidney4%

Rectum4%

Stomach5%

Ovary5%

Lung4%

Other27%

Breast17%

Skin16%

Colon5%

Corpus uteri6%

Cervix uteri7%

THE EUROCHIP-2 IN THE EUROCHIP-2 IN LITHUANIALITHUANIA

• 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

0

20

40

60

80

100

120

140

Medical doctors Nurses Hospital beds

Per

10.

000

of p

opul

atio

n

Cities

Other urban andrural

Structure of consumers expenditures

38,3

15,2

5,4 4,4 6,3 3,4 2,6

14,77,6

4,5

18,1

4,94,66,9

54,4

8,8

0

10

20

30

40

50

60

70Urban

Rural

Unemployment rate, total and by sex2002 year: 13.8 both sexes, 14,6 male, 12,9 female.

Cervical cancer screening in Lithuania

Akmenė

Alytus

Anykščiai

Biržai

Ignalina

Jonava

Joniškis

Jurbarkas

Kaišiadorys

Kėdainiai

Kelmė Kretinga

Kupiškis

Lazdijai

Marijampolė

Mažeikiai

Molėtai

Pakruojis Pasvalys

Plungė

Plungė

Prienai

Radviliškis

Raseiniai

Rokiškis Skuodas

Šakiai

Šalčininkai

Šilalė

Šilutė Širvintos

Švenčionys Tauragė

Telšiai

Trakai

Ukmergė

Utena

Varėna

Vilkaviškis

Zarasai

Nation - wide screening Nation - wide screening started from July 1, 2004started from July 1, 2004

750 000 woman at age 30-60 750 000 woman at age 30-60 are on the target with interval of 3 yearsare on the target with interval of 3 years

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

Better financing – better results?Better financing – better results?

Program financingProgram financing

2004 m.2004 m. - - 660 000 Lt (191 000 EUR) 660 000 Lt (191 000 EUR)

2005 m.2005 m. - 2 654 000 Lt (768 000 EUR) - 2 654 000 Lt (768 000 EUR)

2006 m.2006 m. – – 2 000 000 Lt (580 000 EUR)2 000 000 Lt (580 000 EUR)

... more than 50... more than 50% committed funds % committed funds are not usedare not used

Program problems

... but

... still no centralised invitation system

Survey to identify the screening barriers

• Two surveys has been carried out to identify the screening barriers in the country.

• 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)

First survey:

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

35-49 50-64 65-74

Amžius

Didieji miestai

Kiti miestai

Kaimas

Atv. skaičius

The invitation to join the programme

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 Municipality A: Invitation mailed

to the woman with information to visit the primary health care

center

Survey to identify the screening barriers

• Questionnaire on attitude on screening programm, the visits to gynecologist, knowledge of risk factors and HPV

Next survey:

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%)

180

(23.94%)

752

30-60 269

(92.76%)

17

(5.86%)

290

>60 25

(75.76%)

7

(21.21%)

33

Total 865

(80.47%)

204

(18.98%)

1075

Frequency visit to gynecologist

Age 1-2 time a year

Never or rare

Total

<30 191

(25.39%)

561

(74.6%)

752

30-60 162

(55.86%)

128

(43.79%)

290

>60 17

(51.51%)

15

(45.45%)

33

Total 370

(34.42%)

703

(65.4%)

1075

Do you know about HPV?

Age Yes No Total

<30 454

(60.37%)

295

(39.23%)

752

30-60 209

(72.07%)

75

(25.86%)

290

>60 24

(72.73%)

5

(15.15%)

33

Total 687

(63.91%)

375

(34.88%)

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