engleski

Cervical cancer epidemiology

Cervical cancer is the second most common cancer site in the world, and even though 80% of the world's cervical cancer burden is in the less developed countries, there are still approximately 65, 000 yearly incident cases and 32, 000 deaths in Europe. With approximately 9, 000 incident cases, and 4, 600 deaths of cervical cancer, the South-East Europe as the area of the highest cervical cancer incidence and mortality (estimates for 2004). This region also includes countries with the highest burden of cervical cancer in the whole Europe: Serbia and Montenegro and Romania. Mortality rates in the region are also high when compared to the European average. It is by now well documented that cervical cancer is a disease of infectious origin, with an infection by carcinogenic HPV types as the neccessary cause. Therefore, its incidence trends reflect the trends of infection by carcinogenic HPV types on one side, and the effects of screening activity on the other. The further effect expected to reflect on cervical cancer trends in the next decades will be the introduction of vaccination against HPV. The vaccines against HPV types 16 and 18 have been available on the market since recently, and cohort studies have been set up for long-term evaluation of these vaccines in prevention of invasive cervical cancer and cervical cancer deaths as the endpoints. Regardless of this recent possibility, organised screening programmes still remain the main tool for cervical cancer control in population. However, screening intervals will have to be modified in the future, and comprehensive prevention programmes envisaged. Ever since its introduction, the Pap smear has been the most effective cancer screening test so far, and resulted in great reduction of cervical cancer burden in the developed world. There is evidence from case-control and cohort studies that organised screening is more effective in reduction of cervical cancer incidence and mortality, as well as more cost-effective than opportunistic screening. Also the recommendation of the European Council from 2003 states that cancer screening should only be offered on a population basis in organised screening programmes, with quality assurance at all levels. The recommendation also suggests that Pap smear screening for cervical cancer precursors should not start before the age of 20, and not later than the age of 30. In 2005, the International Agency for Research on Cancer published the overall evaluation that there is sufficient evidence that screening for cervical cancer precursors every 3-5 years between the ages of 35 and 64 years by conventional cytology in a high-quality programme reduces the incidence of cervical cancer by 80% or more among the women screened. Also there was sufficient evidence that the efficacy of HPV testing, using a validated system, as the primary screening modality can be expected to be at least as good as that of conventional cytology. In Croatia, opportunistic cervical cancer screening has been in place ever since 1960s, resulting in decreasing incidence and mortality trends through to 1991. However, in spite of the increase of yearly number of Pap-smears in the health care system, no further decrease has been observed over the last two decades. Even though the cervical cancer incidence in Croatia (W-ASR 10.6/100, 000 in 2006) is lower than in the most of the countries in the region, the rates are still higher than in the countries with organised cervical cancer screening programmes, and there are still estimated 150 cervical cancer deaths yearly. In 2003, a working group of the Croatian Ministry of Health was appointed to propose a national cervical cancer screening programme. The proposal followed the first edition of the European guidelines for quality assurance in cervical cancer screening. The target population were all Croatian women in the age-range 25 to 64 years. In the first phase of the programme, the target population 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. Regarding the present costs of treatment and sick-leave of cervical cancer patients, it was estimated that the introduction of cervical cancer screening programme in Croatia would be cost-effective already after the first decade.

cervical cancer; incidence; mortality

nije evidentirano