Cervical cancer screening program ZORA after five years of introduction at national level shows good public health results

Abstract

Five years after the introduction of the cervical cancer screening program organized in Slovenia at the national level, its results may be observed in public health. The first one is a good compliance of women, i.e. the proportion of women aged 20–64 who had at least one PAP smear taken in a three-year period which is the recommended screening interval in our country. In the last three years (2006–2008), the compliance was 71.2%. Looking at five years, which is the screening interval in Finland and in Great Britain, the compliance is 82.1%. In Britain, in the same period, the compliance was 78.6%, and in Finland, it has not exceeded 70% for several years.
The second public health result is a smaller number of new cervical cancer cases. In five years, the cervical cancer incidence decreased by more than a quarter (28%). In 2003, 209 new cases were registered in the Cancer Registry of Republic of Slovenia, while in 2007, there were 151 new cases.
In 2007, 260.684 smears from 235.713 women were registered in the Screening Registry. Altogether 194.163 women (82%) attended screening examination, while others were coming for follow-up or had clinical symptoms. In the histology registry, 8.569 exams were registered; more than half were made for diagnostic purposes.
It would certainly be difficult to achieve such good results without great endeavors of all gynecologists at primary health care level, all screeners and cytopathologists in all Slovenian laboratories and all other experts involved in multidisciplinary process of screening, diagnostics and treatment. Their good collaboration in achieving further progress is greatly appreciated.

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Povzetek

Program ZORA po petih letih delovanja na državni ravni že kaže javnozdravstvene rezultate. Prvi je velika pregledanost žensk, torej odstotni delež žensk, starih 20–64 let, ki so v treh letih, kolikor je priporočeni interval med presejalnimi pregledi, opravile vsaj en pregled brisa materničnega vratu. V zadnjem obdobju (2006–2008) je stopnja pregledanosti pri nas 71,2-odstotna. Če preračunamo pregledanost na pet let, kot je presejalni interval na Finskem in v Veliki Britaniji, torej v državah, ki so drugim v Evropi zgled, je pri nas ta stopnja 82,1-odstotna. V Veliki Britaniji je bila v istem obdobju 78,6- odstotna, na Finskem pa že dolga leta ne presega 70 %. Drugi je manjše število novih primerov raka materničnega vratu (incidenca raka materničnega vratu). Incidenca raka materničnega vratu se je v petih letih delovanja presejalnega programa zmanjšala za dobro četrtino (28 %), z 209 novih primerov leta 2003 na 151 novih primerov leta 2007.
Podatki Registra ZORA kažejo, da je bilo v letu 2007 pri 235.713 ženskah odvzetih in pregledanih 260.684 brisov. Na presejalnem pregledu je bilo 194.163 žensk (82 %), druge so prišle na kontrolni pregled ali pa so imele klinične težave. V registru histoloških izvidov je bilo registriranih 8.569 izvidov, skoraj dve tretjini (nekaj več kot polovico) je rezultat diagnostičnih posegov.
Dobrih rezultatov zagotovo ne bi bilo mogoče doseči brez prizadevanja številnih ginekologov v primarnem zdravstvenem varstvu žensk, presejalcev in citopatologov v laboratorijih in vseh drugih strokovnjakov, ki sodelujejo v multidisciplinarnem postopku presejanja in zdravljenja predrakavih in rakavih sprememb materničnega vratu. Želimo si, da bi skupna prizadevanja dajala podobne, če ne še boljše rezultate tudi v prihodnje.