engleski

Cervical cancer incidence in Croatia: 15 years of standstill

Background: Even though the effects of organised screening programmes on reduction of cervical cancer incidence have been well documented, such programmes are operational in only 11 European countries, and cervical cancer still remains an important cause of female cancer incidence and mortality. Croatia is a country with 4.4 million inhabitants, situated in South-East Europe, the European area with the largest burden of cervical cancer. In spite of a long tradition of gynecological cytology and opportunistic cervical cancer screening in Croatia, apart from some localised efforts, there have not been population-based organised screening programmes. In 2003, a working group of the Croatian Ministry of Health was appointed to propose a national cervical cancer screening programme. In the first phase of the programme, the target population (women 25-64) would be tested by Pap-smear every third year. In the second phase, introduction of HPV-testing for women older than 30 years was also envisaged. Organization of the programme at county level was proposed, while the evaluation and monitoring would be performed both at county level and centrally. The proposal was published, but has not been implemented in practice so far (Fig1). Objectives: To present cervical cancer incidence and mortality in Croatia and to propose preventive strategies for cervical cancer in Croatia Methods: Croatian National Cancer Registry data were used for cervical cancer incidence, the Croatian National Bureau of Statistics and WHO mortality database data were used for mortality. Results: In Croatia, cervical cancer is the 8th most common female cancer with an average 330 incident cases yearly (ASR-EU 12/100000). After an early decrease of cervical cancer incidence following the introduction of opportunistic screening by Pap-smear in Croatia in 1960s, no further decrease has been observed since the 1990s. In the period 1985-2005, even an increase of incidence in the age-groups 40-44 and 45-49 years has been observed. Mortality rates are difficult to estimate, since in addition to about 100 cervical cancer deaths yearly (ASR-EU 3.6/100000), there are about 100 deaths of “ malignant neoplasm of the uterus, part not specified” . No reductions in either cervical cancer or “ uterus unspecified” cancer mortality have been observed over the last 20 years. Conclusions: Cervical cancer incidence in Croatia is lower than in other South-East European countries, but it is still twofold higher than in countries with a long tradition of organised screening programmes. It is obvious that there is no further effect of opportunistic screening in Croatia, and introduction of an organised cervical cancer screening programme is essential to reduce cervical cancer incidence and mortality. To achieve further reductions in cervical cancer burden in the future, introduction of HPV vaccination should be planned. References: 1. Arbyn M, Primic-Žakelj M, Raifu AO et al. The burden of cervical cancer in South-East Europe at the beginning of the 21st century. Coll Antropol 2007 ; 31(Suppl 2): 7-10. 2. Arbyn M, Raifu AO, Autier P, Ferlay J. Burden of cervical cancer in Europe: Estimates for 2004. 3. Croatian National Institute of Public Health. Cancer Incidence in Croatia. Bulletins No. 1-30. Croatian National Institute of Public Health, Zagreb, 1983– 2007 . 4. International Agency for Research on Cancer. Cervix cancer screening. IARC handbooks on cancer prevention Vol 10. IARC Press, Lyon, France, 2005. 5. Znaor A, Babić D, Ćorušić A, Grce M, Mahovlić V, Pajtler M, Šerman A. [Proposal of cervical cancer early detection programme in Croatia] Liječ Vjesn 2007 ; 129: 158-163. 6. Znaor A, Strnad M. Cervical cancer in Croatia: state of the art and possibilities for prevention. Coll Antropol 2007 ; 31(Suppl 2): 37-40. 7. www.ecca.info

cervical cancer; incidence; Croatia

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