1. Cervical cancer screening in Estonia: present situation Piret Veerus Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn, Estonia

2. Cervical cancer in Estonia  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 from 1980-82 to 1998-2000

3. Estonian Cancer Registry 2003 Age-specific incidence of cervical cancer in Estonia, 1980-2000

4. Ferlay et al. GLOBOCAN 2002 Mortality from cervical cancer in Northern Europe in 2000

5. Cervical cancer screening in Estonia  Around 140,000 Pap-tests performed yearly during daily medical practice in Estonia  Opportunistic cervical cancer screening started in 2003 in three regions  The Estonian Health Insurance Fund mailed invitations to a random sample of female population aged 30 to 40 yrs  Only 21.7% of the 12,960 invited women attended the screening, in 7% the results was abnormal

6. Cervical cancer screening in Estonia  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  In 2004, 5264 women attended, 6% abnormal test  In 2005, 6552 women attended, 6% abnormal results

7. New Cancer Strategy  Presented to the Ministry of Social Affairs in 2005  Includes the needs, structure, methodology and budget forecast for cancer screening programmes in Estonia  Inludes the need for establishment of a screening registry and reference laboratory  Screening should cover the whole population, not only insured persons

8. Cervical cancer screening in Estonia since 2006  Target group for cervical cancer screening women aged 30 to 59 yrs  Screening interval 5 yrs after a negative result  Pathological results handled according to clinical guidelines  Funding for the screening registry, reference laboratory and non- insured women needed

9. Cervical cancer screening in Estonia since 2006  In 2006, personal invitations mailed to birth cohorts 1951, 1956, 1961, 1966, 1971  Trained midwives take Pap-smears at 19 clinics, tests performed at 7 labs  In the first 3 months of 2006, 57% (n=2305) of the invited women participated in cervical cancer screening

10. 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 nationwide screening programme  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

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

12. Thank You!