Professional paper
https://doi.org/10.69827/bhdmi-31035
Integration of monitoring preventive activities related to early detection of cervical cancer in the Republic of Croatia
Maja Vajagić
orcid.org/0000-0002-0024-3753
; „Dr. Andrija Štampar“ Teaching Institute of Public Health, Zagreb, Croatia
*
* Corresponding author.
Abstract
The National Program for the Early Detection of Cervical Cancer (further: the Program) was conducted in the Republic of Croatia as organised national screening from December 1, 2012, until 2016 using the PAP test as the screening method. Concurrently, opportunistic screening with the PAP test has been carried out for decades and is provided by primary gynaecologists. Although one of the goals of organised national screening is the abolition of opportunistic screening, one of the temporary possibilities for improving the Program is the integration of organised national screening and opportunistic screening, considering the availability of gynaecology teams at the level of primary care. The prerequisite for the integration is a high-quality IT solution, which has been available as of recently. This IT solution was built on a common platform for all three national programs for early detection of cancer (breast, colon and cervix), and is connected to the systems of CEZIH (Central Health Information System of the Republic of Croatia) and ZOROH (Business Database of the Croatian Health Insurance Fund (HZZO)), which are important sources of data on citizens, and are currently fully functional with defined business processes. The Program is implemented and all women between the ages of 25 and 64 are invited by paper invitation by county public health institutes, with the screening interval of three years. Invitations to women who have had a PAP test within the public health system in the past year (based on the HZZO invoices) have been temporarily postponed. Along with the invitation, the name of the woman’s gynaecologist is included, and in case the woman is not on any gynaecologist’s list, names of three available nearby gynaecologists are listed with whom the woman can register if she so wishes. The woman comes to the gynaecologist with the invitation (which also includes a kupovnica or the paid referral for the Program), a sample is taken and sent to the cytological laboratory, and the findings are sent to her gynaecologist once available. A change in the system of organised national screening would be that, given that information (and a reminder) is available from the county public health institute (as well as an alternative method of invitation chosen by the woman), the gynaecologist invites women that are registered with their team. For women who do not have a chosen gynaecologist, invitations are sent by paper invitation (or by other means if the woman has opted for an alternative method of communication) and recorded in the IT system by county public health institutes with a list of three gynaecologists that are available for selection. The woman either chooses one recommended gynaecologist, or if she does not wish that, only the sample for a PAP test is taken in the proposed gynaecological team and the PAP test is performed. For cytological laboratories, the procedure remains the same for the PAP test. Additional human papillomavirus (HPV) testing is recommended for women aged 30 to 65 years, taking into account the HPV vaccination status, and the prescribing, implementation, and information integration process is the same as for the PAP test. With this program integration, the responsibility of gynaecologists, for whom this is one of the basic preventive activities, would be increased, and women without a chosen gynaecologist would be further encouraged to choose one, which would ensure better coverage of the female population with primary care gynaecology services.
Keywords
Uterine Cervical Neoplasms; Early Detection of Cancer; Diagnostic Screening Programs; Gynecology
Hrčak ID:
319739
URI
Publication date:
24.7.2024.
Visits: 233 *