Cervical cancer screening in Serbia

Cervical cancer is the second most common female malignancy in Serbia, after breast cancer, with 1089 new registered cases and an age-standardized incidence rate of 27.2 per 100,000 women in 2002. It is the fourth leading cause of cancer death with 452 deaths and an age-standardized death rate of 7.2 per 100,000 women. Compared with other European countries, the incidence of cervical cancer in Central Serbia is the highest. Regional differences in incidence are pronounced in Serbia with the lowest age-standardized incidence rate (16.6 per 100,000 women) registered in the Macvanski region and the highest in eastern Serbia and the region of Belgrade where the rates are double at 32.5-38.1 per 100,000 women. Cervical cancer prevention in Serbia has relied on opportunistic screening that is characterized by high coverage in younger and low coverage in middle-aged and older women. Screening of selected groups of women employed in large companies is performed annually by many regional hospitals but this approach has little effect on morbidity and mortality. Recently, the Ministry of Health nominated an Expert Group to develop and implement a national cervical cancer screening program. A number of pilot projects have been undertaken with the results used for development of a national programme for cervical cancer screening. This is expected to be finalized in 2007, and launched over a 3-years period in order to cover all women aged 25-64 in entire Serbia.     

Preventing iron deficiency in preschool children by implementing an educational and screening programme in an inner city practice.

OBJECTIVE--To assess the feasibility and acceptability of screening young children for iron deficiency in a deprived inner city practice and to assess the effects of a programme of dietary education. DESIGN--Prospective study of children in general practice, comparison with historical controls. SETTING--A deprived inner city practice. PATIENTS--127 Children aged 13-24 months. Findings were compared with those in 110 children of the same age studied previously. INTERVENTIONS--All mothers received dietary education antenatally and in the first year after giving birth. Screening for iron deficiency (defined as mean cell volume less than 75 fl and haemoglobin concentration less than 105 g/l) and haemoglobinopathy (when appropriate) was offered for all children attending for immunisation against measles, mumps, and rubella over 12 months; capillary blood samples were taken after immunisation. MAIN OUTCOME MEASURES--Uptake of the screening programme expressed as the percentage of all children eligible for immunisation who were screened, and the effectiveness of the dietary education as shown by the prevalence of iron deficiency in the two groups. RESULTS--Altogether, 122 of the 127 (96%) children who attended for immunisation had their haemoglobin concentration and mean cell volume measured; 90% of all children aged 13-24 months in the practice were screened. Dietary education, clinical procedures, and counselling were incorporated successfully into the clinic''s work. Ten children (8%) were iron deficient, all of whom responded to iron supplements, and eight had a haemoglobinopathy trait. In the previous study 110 children (70%) had been screened and 28 children (25%) had been iron deficient. The two groups were similar in terms of sex, social class, and ethnic group. CONCLUSIONS--Screening young children for iron deficiency, sickle cell disease, and thalassaemia when they attended for immunisation was acceptable and successful in a socially deprived inner city practice. Dietary education may have accounted for some of the reduction in the prevalence of iron deficiency that occurred over the two years.     

Cervical cancer screening, screening errors and reporting

Screening for cervical carcinoma by cervicovaginal cytology has led to a marked reduction in the incidence of and mortality from this tumor over the last 50 years in essentially all countries with a functioning screening program. It is the most successful cancer prevention program of all times. Consequently, approximately 80% of the current incidence of and mortality from this disease occurs in geographic areas of underserved and underscreened women. Essential components of a successful program are a high coverage rate of the female population, screening at regular intervals, well-trained clinical and laboratory staff, and an efficient follow-up and treatment system. Deficiencies in any of these areas may lead to a failing screening system. Thus, the most important reason for the remaining mortality from cervical carcinoma in developed countries is lack of complete coverage. It is questionable if new and more expensive technologies will be able to renmedy the remaining failures of the system if no improvement in the coverage rate is achieved. Screening errors do occur but represent only a small fraction of screening failures. Currently, there are a number of terminology systems around the world; thus, a unified terminology is currently not a realistic goal.     

Cervical cancer screening in the Czech Republic

Cytological diagnosis of atypical cells of cervix uteri by the Papanicolaou method was introduced in the Czech Republic (CR) very early - in 1947. The first data on the incidence of cervical cancer in CR are available from 1960 when the rate was 32.3 cases/10(5) women. In 1966 the Czech National Health Law was passed that guaranteed women a yearly preventive examination by a gynaecologist including screening for cervical carcinoma that would be covered by the compulsory health insurance. Notwithstanding high frequency of screening visits and the fact that all women are eligible, the incidence of CC has not changed in the last 34 years. The reasons for this include the coverage of Czech women, which is estimated to be low (50% at the most), and that none of the cytology laboratories are accredited for screening, there are no national registries for any aspect of screening and there are no mechanisms for evaluation of the screening process. As a result, it is likely that the majority of cervical screening activity that is undertaken is ineffective and the implementation of an organised and quality controlled screening programme, in compliance with the recommendations of many European Institutions, is urgently required to ensure that Czech women are properly protected against this disease and that scarce healthcare resources are used in the most cost-effective manner.     

Effectiveness of population-based colorectal cancer screening programme in down-staging

BackgroundThis is the first evaluation study to assess the demographic characteristics of the colorectal cancer (CRC) cases detected in the prevalent round of the population-based Colorectal Cancer Screening Programme (CRCSP) in Hong Kong and to explore the effectiveness of the programme on the stage distribution of CRC.MethodsThis study covered the period between 28 September 2016 and 31 December 2018. Information on CRC diagnosis, age and stage at diagnosis were retrieved and reviewed by the Hong Kong Cancer Registry (HKCaR). The CRC detection rate among CRCSP-screened participants and incidence rate among the Hong Kong general population were calculated respectively. The odds ratio (OR) was calculated to measure the strength of association and quantify the effect of CRCSP on stage shift between CRCSP-detected CRC cases and an age-matched cohort of CRC cases diagnosed outside the programme.ResultsThe CRC detection rate among participants of the CRCSP during the study period was 736.0/100,000, whereas the overall CRC incidence rate among general population of similar age groups was 393.7/100,000. For all ages and both sexes, the OR of stage I CRCSP-detected CRC compared to the CRC from the age-matched cohort was 3.91 (95%CI=3.41–4.48) and the OR dropped to 0.54 (95%CI=0.41–0.70) at stage IV. Meanwhile, the overall OR of CRCSP-detected CRC compared to CRC from the age-matched cohort dropped from 2.24 (95%CI=1.97–2.56) to 1.62 (95%CI=1.40–1.87) with increasing age.ConclusionThe present study has demonstrated the initial impact of the CRCSP on shifting the stage at diagnosis towards earlier stage. The benefit of stage-shift was similar for all ages from 60 to 77 in both sexes and seems to increase with younger age. Given the stage-dependent survival outcomes, this stage-shift could lead to a reduction in CRC-associated mortality in Hong Kong in future.     

湿地生物多样性监测的指标体系和实施方法:以北美大湖湿地为例

我国湖泊湿地面积大,动植物资源十分丰富,但受人类活动干扰强烈,退化较为严重。湖泊湿地生物多样性监测是湖泊湿地生物多样性保护和研究的重要环节。在一些发达国家相关的工作已较为成熟,我国尚处于起步探索阶段。本文介绍了北美大湖湿地生物多样性监测项目的指标体系和实施方法,旨在为建立我国的湖泊湿地生物多样性监测网络提供借鉴与启示。北美大湖湿地共设置约1,500个监测样点,研究人员通过每年对水体环境和五大生物类群(植物、底栖无脊椎动物、鱼类、两栖类、鸟类)进行野外调查和数据采集,构建生物完整性指数(index of biotic integrity,IBI),以评价大湖湿地生物多样性和生态环境健康的现状及未来的变化趋势,为湿地的保护和管理提供重要依据。北美大湖湿地生物多样性监测方法不但具有较强的科学性和系统性,并且可操作性强,对构建我国湖泊湿地的生物多样性监测方案有参考价值。     

Cervical cancer screening: A Slovenian experience

In Slovenia, opportunistic screening was introduced in regular gynaecological practice in 1960. The proportion of population screened was unknown, as well as there were no standards for quality assurance and control. Despite great number of smears read, there were no major changes in invasive cervical cancer incidence in the period 1979 till 1993, but in 1994 the incidence rate started to increase again to reach its peak in 1997 (23,1/100.000, 241 new cases). Based on the experiences from the countries with effectively organised screening programmes, a decision was made in 1996 by the Minister of Health to nominate a group of experts to prepare a proposal for organised cervical cancer screening programme after testing the methodology in pilot study. In the pilot the central computerised information system (Screening Registry) was gradually established to register all smears from the whole country, to identify women who do not attend for screening to send them invitation for screening and to monitor screening activity and its quality. The aim of pilot was also to develop guidelines for quality assurance and control of all procedures involved in cervical cancer screening and treatment of intraepithelial lesions. In three years since the beginning of the national programme, nearly 70% of women in the target age group were registered with at least one smear. All other results are presented in regular programme reports. There is still place for further development of the programme, but the incidence of cervical cancer already started to decline especially among younger women, who attend for screening more often than those aged over 50.     

Cervical cancer screening from the public health perspective

Many state health departments have a significant role in cervical cancer screening. Given that role, a group of public health personnel from eight southeastern states drafted a set of questions and quality assurance issues to be discussed with a laboratory under consideration as a contract provider of cytology services. The major points of concern included: (1) quality of laboratory services (accreditation, personnel, facilities and operational and quality control procedures); (2) quality of sampling (including techniques used and the training and monitoring of sample takers); (3) terminology for cytology reporting; and (4) protocols used for diagnostic evaluation of abnormal Papanicolaou smears.     

Cervical cancer screening in Mediterranean countries: implications for the future

K. Syrjänen, L. Di Bonito, L. Gonçalves, L. Murjal, M. Santamaria, V. Mahovlic, P. Karakitsos, B. Önal and F. C. Schmitt Cervical cancer screening in Mediterranean countries: implications for the future Prompted by feedback from the 34th European Congress of Cytology (ECC), the practice of including a special symposium in the programme was continued in the 35th ECC in Lisbon (2009) by arranging a satellite symposium entitled ‘Cervical Cancer Screening in the Mediterranean Countries’. Because of the importance to the future of this discipline, it was felt appropriate to summarize the highlights of this symposium here. Cervical cancer prevention strategies in the countries participating in the symposium (Portugal, Spain, Italy, Croatia, Greece and Turkey) appear to be highly variable. As yet, none of these countries can demonstrate a fully implemented national screening programme, but all are in different phases of designing and/or setting up such a programme, which is important. At present, the time‐honoured concept of cervical cancer prevention by Pap smear screening is under review, because prophylactic human papillomavirus (HPV) vaccines demonstrate a potential to prevent the vast majority (albeit not all) of cases of cervical cancer in the foreseeable future. Cervical cancer screening is still needed in this emerging era of HPV vaccination, but clearly the existing screening strategies must be modified to provide a cost‐effective combination of vaccination and screening. If the currently evaluated new screening strategies, such as HPV testing followed by cytology triage, become a reality, there is the likelihood that the Pap test will have only a secondary role, subordinate to HPV testing. Supporters of this scenario claim that Pap test performance will deteriorate in vaccinated populations. Reduced positive predictive value (PPV), due to lower disease prevalence, is inevitable, however, and this would also affect HPV tests. Any decline in sensitivity and specificity depends on human performance, and as such is avoidable by taking appropriate preventive measures. As clinical cytologists, we should focus attention on minimizing the risk to the Pap test of falling sensitivity because of unfamiliarity with abnormal cells, and also of reduced specificity if the fear of missing significant disease leads to overcalling of benign abnormalities.     

Immunofluorescence with monoclonal antibodies on poly-L-lysine coated slides: an alternative to conventional methods

It is sometimes difficult to perform immunofluorescence tests because of low cell numbers. Therefore a simple method using poly-L-lysine coated slides was applied to immunofluorescence and compared with the routine suspension method. Peripheral blood lymphocytes from normal persons, samples of normal bone marrow, thymus and tonsil as well as samples from patients with leukemia or lymphoma were tested with these two methods using 20 different monoclonal antibodies. The PLL-slide method was shown to be comparable with the suspension method and is an alternative in case of low cell numbers, since as few as 3 X 10(4) cells can be tested for one antigen.     

Participation in a government-subsidised colorectal cancer screening programme for asymptomatic individuals in Hong Kong

BackgroundA Government-subsidised colorectal cancer screening programme (CRCSP) was launched in Hong Kong. This study aimed to assess the participation rate in CRCSP among Chinese individuals between the ages of 50 and 75 years and to survey individuals’ reasons for declining to participate in the CRCSP.MethodsA cross-sectional study was performed. Asymptomatic Chinese individuals aged 50–75 years in Hong Kong who did not have a history of colorectal cancer were recruited. A survey was used to collect information about individuals’ participation in the CRCSP.ResultsThe survey was completed by 1317 participants. Of these, 432 (32.8%) joined the CRCSP and the remaining 885 participants (67.2%) did not join the CRCSP. The most common reason that participants provided for not joining the CRCSP was thinking that the screening was not necessary because they had no health problems (29.3%). Some (14.4%) of the participants claimed to lack information about the CRCSP and screening procedures. Some (12.5%) of them completed the screening before the CRCSP was launched, and the cost was covered by other sources.ConclusionThe participation in CRCSP for a screening among the Hong Kong population has generally increased, but obstacles to participating in screening programme remain.