engleski

Cervical Screening in Croatia – Primorsko-Goranska County Experience

Since the introduction of the Pap test in 1950s, opportunistic cervical cancer screening is present in Croatia until today. The decrease of cervical cancer incidence and mortality was noted, but after 1990 it has reached unchanging level of about 15/100 000 and 5/100 000, respectfully. A wide network of primary care gynaecology units provide women health care covered by national health insurance. Cytology in Croatia has a long tradition in education of cytologists and cytotechnologists with a high level of quality. In 2011, 39 cytology laboratories in 23 cities were registered, with total number of 458 850 Pap smears. In Primorsko-Goranska County a pilot programme ‘Early detection of cervical cancer in women of Primorsko-Goranska County’ was conducted from 2006 to 2011. Target groups were women from 20 to 64 years. Out of the patients of each primary care gynaecologists, 1000 women were invited by personal letter. In the first 2 years the women were randomly selected, but later on were invited those not attending gynaecologist for three and more years. The participation rate was 41%. The lowest participation rate (33.3%) was observed in the youngest group of women (20–29) and the highest (60.7%) in the oldest group (60–64). The detection rate of cytological abnormalities was 4.5%, with unsatisfactory rate of 0.5% and 17.2% suboptimal smears. Low participation rates and shortage in the number of primary care gynaecologists were the main negative issues of the programme, providing valuable experience on what problems to focus in the future planning of the national screening. In Croatia, the first attempt to introduce national organised cervical screening was done in 2003. Namely, Working Group for Development of the Program of Early Detection of Cervical Cancer in Croatia, within the frame of the Ministry of Health and Social Welfare of the Republic of Croatia, submitted a Draft Program with clearly stated goals and methodology including quality control. Proposed screening intervals were 3 years for women age 25–64 and a conventional Pap smear was recommended as a screening method. In 2012 Commission for Implementation of the National Programme of Early Detection for Cervical Cancer, named by the Ministry of Health, has taken further steps in preparing the basis for start up the programme. Its main goals are to create a national screening register, programme software with network connection and detailed protocol for conducting every step of the programme. Call letters will be sent by primary care gynaecologists. In cytology laboratories, all the data, including the cytology findings will be recorded providing the basis for future recall or immediate workup, if necessary. Proactive attitude, especially of gynaecologists, isdemanded with the purpose to replace the opportunistic with organised screening, subsequently. All steps of the programme will be coordinated and controlled by Institute for Public Health in each county and by the national commission. The intension is to start the Programme during this year, because in Croatia all professional preconditions as well as a solid governmental support for organising effective cervical cancer screening are fulfilled now.

Cervical Screening; Croatia; Primorsko-Goranska County

nije evidentirano