Task Force on Cervical Cancer Screening in Estonia Piret Veerus Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn, Estonia

Background ASIR(w) of cervical cancer 14.1 per 100,000 women yrs in 2003 In 2003, 143 new cervical cancer cases detected Among the female population, the 6th most common cancer site, In the age-group from 20 to 49 yrs the incidence rates almost doubled in 1980-82 to 1998-2000

Age-specific incidence of cervical cancer in Estonia, 1980-2000

Mortality from cervical cancer in Northern Europe in 2000

Cervical cancer screening in Estonia in 2003-2005 Opportunistic cervical cancer screening started in 2003 in three regions Invitations mailed to a random sample of insured women aged 30 to 40 yrs Since 2004, all Estonian regions were included Target group in 2004 and 2005 women aged 35 to 40 years and being insured Women invited to cervical cancer screening tests via media

Cervical cancer screening in Estonia since 2006 Organized screening started in 2006 according to the National Cancer Strategy Target group for cervical cancer screening women aged 30 to 59 years Screening interval 5 yrs after a negative result Trained midwives take Pap-smears at 19 clinics, tests preformed at 7 labs Pathological results handled according to clinical guidelines

Cervical cancer screening in Estonia since 2006 The Estonian Health Insurance Fund is funding the screening programme The Estonian Cancer Society carries out the technical work (mailing of personal invitations and reminders, collection of data from clincs and labs about attendance rates, test results, and possible additional investigations) Funding for the screening registry, reference laboratory and non-insured women needed

Planned action in the framework of Eurochip-2 Comparative study on coverage of the female population by Pap-tests and numbers of primarily detected cervical cancer cases before and after introducing the organized screening programme

Objective of the Eurochip-2 Task Force in Estonia To produce knowledge for improving the population coverage by Pap-tests and for increasing the proportion of primarily diagnosed cervical cancer cases in early stages

Outcome measures Primary outcome measure: proportion of the female population covered by Pap-tests in 5-year age groups in different regions Secondary outcome measure: proportion of primarily detected cervical cancer cases in different cancer stages, including in situ carcinomas

Data collection Data about numbers of women in different age groups in each region from the Estonian Population Registry Data about the number of performed Pap-tests from the Estonian Health Insurance Fund Data about the results of Pap-tests and additional investigations from the screening programme Data about primarily detected cervical cancer cases from the Estonian Cancer Registry

Additional tasks To compare the proportion of different test results (LSIL, HSIL, ASC-H, ASC-US, AGC, unsatisfactory, other) in different labs To compare the database of the Estonian Health Insurance Fund, of the Estonian Cancer Registry, and of the screening programme

Milestones Task: Timetable: Data collection February 2006 - June 2007 Data analysis July 2007 - October 2007 Report October 2007 - November 2007

Working group for Eurochip-2 Task Force in Estonia Epidemiologists from the National Institute for Health Development Researchers from the Estonian Cancer Registry Representatives from the Estonian Cancer Society, Estonian Health Insurance Fund, Estonian Gynaecological Association, and Estonian Ministry of Social Affairs