Stručni rad
Organisation of Cervical Cytology Screening in Croatia: Past, Present and Future
Marija Pajtler
Silvana Audy-Jurković
Ika Kardum-Skelin
Vesna Mahovlić
Danijela Mozetić-Vrdoljak
Ana Ovanin-Rakić
Sažetak
This presentation highlights strengths and weaknesses of cervical cytology screening in Croatia, with particular reference
to the opportunistic screening, the use of conventional Papanicolaou (Pap) test and the analysis of some organizational,
educational and performance issues that are associated with it. Its aim is to propose measures to improve the efficacy
of cervical cytology screening in order to reduce cervical cancer mortality. Currently, in excess of 450,000 Pap tests/
year are examined at 35 laboratories scattered throughout the country. All of these laboratories use standard operating
procedures including internal and external quality control. They employ a total of 68 cytologists and 91 cytotechnologists.
The sensitivity of cervical screening in Croatia is 90.0%, specificity 98.6%, positive predictive value 92.3%, negative
predictive value 98.1% and overall diagnostic accuracy 97.2%. The high diagnostic accuracy of cervical cytology is
attributed to the long-standing tradition of education and training of cytologists (postgraduate MSc course since 1967,
independent residency since 1974) and cytotechnologists (since 1968). This tradition spanning more than half a century
means that today in Croatia there is a developed network of cytology laboratories staffed by highly competent cytologists
and trained cytotechnologists. The high accuracy of cancer detection through Pap tests provides strong evidence in support
of cervical cytology screening remaining the basic method of prevention for cervical carcinoma. However, some modifications
to the current situation are needed. These relate primarily to opportunistic screening. The current screening
coverage rate is 68%, although there is capacity, which would allow for all women at risk, i.e. those aged 25–64, to be
screened once in three years. The screening coverage relates mainly to those women visiting gynecological out patient
clinics for unrelated conditions. A properly organized and controlled national screening programme should replace this.
This should be accompanied by the introduction of alternative, highly sensitive methods of sample collection and preparation,
such as are available through the introduction of new technologies, e.g. liquid based cytology.
Ključne riječi
Pap test; cervical carcinoma; cervical screening programme; Croatia
Hrčak ID:
27461
URI
Datum izdavanja:
13.4.2007.
Posjeta: 1.237 *