Cervical cancer as a public health issue - what next? [Karcinom cerviksa kao javnozdravstveni problem - kako dalje?]

Ćorušić, Ante and Škrgatić, Lana and Mahovlić, Vesna and Mandić, Vjekoslav and Planinić, Pavao and Karadža, Magdalena (2010) Cervical cancer as a public health issue - what next? [Karcinom cerviksa kao javnozdravstveni problem - kako dalje?]. Collegium Antropologicum, 34 (1). pp. 301-307. ISSN 0350-6134

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Abstract

Cervical cancer is the second most common cancer in women worldwide. There are about 60,000 newly detected cases and 30,000 deaths annually in Europe, with the highest incidence reported from Eastern Europe countries. According to data from the National Institute of Public Health, in Croatia the incidence of cervical cancer was 14.9/100,000 in 2006, ranking eighth most common malignancy in women. Croatia has a lower incidence of the disease compared to many countries of Central and Southeast Europe. A large study carried out in 1995 by the International Agency for Research on Cancer, which included cervical cancer material collected from 22 countries all over the world revealed HPV genome in 99.7% of cases. Efficient methods of cervical cancer detection and screening methods for identification of precancerous lesions (conventional Pap smear) are available. Cervical cancer prevention programs should include education (of health care providers and women), stressing the benefits of screening, the age of the peak cervical cancer incidence, and the signs and symptoms of precancerous lesions and invasive disease. The aim of screening actions is to detect precancerous lesions that may lead to cancer if left untreated. Screening can only be effective if there is a well-organized system of follow up, diagnosis and treatment. Cervical cytology, or Papanicolaou (Pap) testing, has for decades been a cornerstone of cervical cancer screening. According to recent guidelines issued by the World Health Organization Regional Office for Europe, the primary task of the public health system is the introduction of secondary prevention through properly organized screening programs. Launching the national immunization program is only possible in the countries with well-organized secondary prevention programs and in those that can afford it.

Abstract in Croatian

Karcinom vrata maternice drugi je najčešći karcinom u žena u svijetu. U Europi se godišnje otkrije oko 60 000 novooboljelih i oko 30 000 žena umre od ove bolesti. Najveća incidencija je u zemljama istočne Europe. U Hrvatskoj prema podatcima Hrvatskog zavoda za javno zdravstvo (HZJZ) incidencija je 2006. godine bila 14.9 i po učestalosti je na osmome mjestu svih malignoma u žene. Hrvatska ima nižu incidenciju ove bolesti od mnogih država srednje i jugoistočne Europe. Veliko istraživanje International Agency for Research in Cancer (IARC) iz 1995. godine na materijalu iz 22 zemlje diljem svijeta otkrilo je u 99,7% svih karcinoma vrata maternice genom HPV-a. Danas postoje dobre metode otkrivanja ove bolesti kao i dobra metoda probira (konvencionalni PAPA-obrisak). Program prevencije karcinoma vrata maternice mora uključivati edukaciju (za zdravstvene radnike i žene) o dobrobiti programa probira, vršnoj dobi pojave karcinoma kao i edukaciju o znakovima i simptomima preinvazivnih i invazivnih promjena. Programi probira su usmjereni prema preinvazivnim lezijama koje mogu dovesti do invazivnih ako se ne liječe. Probir je učinkovit samo ako postoji dobro organiziran sustav praćenja, dijagnostike i liječenja. Citologija cerviksa ili Papanicolau obrisak temeljna je metoda probira za karcinom vrata maternice kroz desetljeća. Prema zadnjim smjernicama Europskog odjela Svjetske zdravstvene organizacije primarna zadaća javnoga zdravstvenog sustava je uvođenje sekundarne prevencije dobro organiziranim programima probira. Organizaciju nacionalnih imunizacijskih programa moguće je aplicirati samo u zemljama s dobro organiziranim programima sekundarne prevencije i u zemljama koje to mogu platiti.

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