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

2. 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 to

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

4. Mortality from cervical cancer in Northern Europe in 2000

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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