engleski

Cervical cancer screening in Croatia

In Croatia, cervical carcinoma is the eighth most common cancer seat in female population, with the annual incidence of 15.6. There are 360 new cases and 114 deaths from cervical cancer per year. A decline in the incidence of invasive cervical carcinoma was recorded between 1970 and 1991, then showing stagnation. The highest incidence of cervical carcinoma is found in the 45-54 and 80-84 age groups, and of CIN III in the 35-39 age group, while the greatest increase in the incidence of cervical carcinoma is recorded in the 20-35 age groups. In Croatia, conventional Pap test has been used as a standard method of secondary prevention of cervical carcinoma for more than half a century now. Pap test has been employed as a form of opportunistic screening, i.e. as a classic test for lesion detection and as a differential diagnostic method. It is obtained by a gynecologist and analyzed by trained cytologists and cytoscreeners. In 37 cytology laboratories organized, there are 80 cytologist is and 111 trained cytoscreeners. More than 450, 000 Pap tests are performed per year ; although this figure could cover all women from the 25-64 age groups at risk once in three years, less than 70% are actually included. Croatia has a long tradition of organized education of cytologists and cytoscreeners. Postgraduate study in Medical Cytology, established at Zagreb University School of Medicine in 1967, has been held 33 times till now with 417 postgraduate students in total. Independent residency in medical cytology, later renamed as clinical cytology, has been performed since 1974. Recent tendencies to achieve harmonization with the European Union have brought efforts to adjust the education in clinical morphological professions of pathology, cytology and forensic medicine accordingly, having resulted in a new proposal of residency in all these three professions with a common trunk. The education of cytotechnologists as additional training after completion of high school for medical technicians was at first held in the form of six-month course (1968-1977), then one-year curriculum (1981-1992). Unfortunately, institution of the two-year curriculum at Health College in Zagreb has not yet been implemented. Since 2000, one hundred-five cytotechnologists have received professional training at five courses organized by the Ministry of Health and Social Welfare of the Republic of Croatia, in collaboration with the Croatian Society of Clinical Cytology of the Croatian Medical Association. The one-year course consisted of 630 hours of practical and theoretical lessons in all fields of cytology, with 200 hours of training at particular cytology laboratories. A unique classification named Zagreb 2002, i.e. a modification of Zagreb 1990 and NCI Bethesda System 2001 classifications, has been used for uterine cervix cytologic findings. In 2003, Working Group for Development of the Program of Early Detection of Cervical Cancer in Croatia, within the frame of the Committee for Prevention of Malignant Diseases of the Ministry of Health and Social Welfare of the Republic of Croatia, submitted a Draft Program with clearly stated goals. The Program would 100 be performed at county level, organized by screening centers at county Public Health Institutes. According to the 2001 census, target population included all women aged 25-64, i.e. 1, 198 299 women in total. As proposed, the first phase would include screening by Pap smear every three years in women aged 25-64 ; and in the second phase in addition to Pap smear HPV test would be introduced for women aged 30-64, with five-year screening intervals. Along with the screening program, the integral system of cervical cancer prevention also includes primary prevention. Conclusion A more than half a century tradition, the network of cytology laboratories with a respectable number of competent cytologists and trained cytotechnicians, and more than 450, 000 Pap tests analyzed per year provide strong arguments for the cytologic screening to remain the basic method of secondary prevention of cervical carcinoma. However, the methodology employed requires modification, first of all substituting opportunistic screening by a well designed, organized and controlled national screening for which all preconditions have been met, then, introduction of alternative methods of higher sensitivity for sample preparation, and new methods in primary and secondary screening.

Cervical cancer screening in Croatia; training in cytology and cytotechnologists

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