CERVIX | CERVICAL SCREENING [ISSN 1804-087X]
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PARTNERS AND EXPERT GUARANTEE
 
Czech Gynaecological and Obstetrical Society | Ministry of Health | Institute of Biostatistics and Analyses, Masaryk University
GRANT SUPPORT OF THE PROJECT
 
GlaxoSmithKline     Roche |

Other sources of information
Cervical cytology (in Czech)www.cipek.cz
Cervical cytology
 
Cancer Screening in the European Unionec.europa.eu
Cancer Screening in the European Union (2017)
[ 10,6 MB]
 
SVOD - Epidemiology of malignant tumours in the Czech Republicwww.svod.cz
Epidemiology of malignant tumours
in the Czech Republic
 
NCI Bethesda System
HPV College

 

Results of personalised invitations of Czech citizens to cancer screening programmes

Ondřej Májek1,2, Ladislav Dušek1,2, Milan Blaha1,2, Jan Daneš3, Miroslav Zavoral4, Bohumil Seifert5, Vladimír Dvořák6, Miroslava Skovajsová7, Štěpán Suchánek4, Tomáš Jung8, Martina Brzková8, Petr Klika1, Dan Klimeš1, Ondřej Ngo1,2, Jana Koptíková1, Lenka Šnajdrová1, Jakub Gregor1

1 Institute of Biostatistics and Analyses of the Masaryk University, Brno; 2 Institute of Health Information and Statistics of the Czech Republic, Prague; 3 Department of Diagnostic Radiology of the 1st Faculty of Medicine at Charles University and General University Hospital in Prague; 4 Department of Internal Medicine of the 1st Faculty of Medicine at Charles University and General University Hospital in Prague; 5 Institute of General Medicine of the 1st Faculty of Medicine at Charles University in Prague; 6 Centre for Outpatient Gynaecology and Primary Care, Brno; 7 BREAST UNIT PRAGUE, Mamma centrum Háje, Prague; 8 Czech Ministry of Health, Prague


Introduction

The project of addressed invitations of citizens to cancer screening programmes was launched in the Czech Republic in January 2014. Health insurance companies send invitations to their clients, and the project is coordinated by the Czech Ministry of Health in cooperation with representatives of the relevant medical societies (gynaecology, gastroenterology, gastrointestinal oncology, diagnostic radiology, general medicine), representatives of health insurance companies, and other leading experts in the field. Invitations are sent to those citizens who do not participate in organised cancer screening programmes in the long term. The introduction of population-based screening is in compliance with the recommendation of the Council of the European Union [1] and with methodical standards for high-quality and functional prevention programmes [2].

The Czech cancer care still faces a significant challenge given by the fact that a large proportion of cancers, including three preventable diagnoses (breast cancer, cervical cancer, colorectal cancer), is primarily detected at advanced clinical stages [3]. Participation rates in Czech cancer screening programmes are rather low, and therefore the situation is not expected to improve any time soon. This is particularly true for colorectal cancer screening, where the coverage rate of the target population is currently only 27%. Although the colorectal cancer screening programme in the Czech Republic is very important for individuals who participate in it, the low population coverage by examination is the reason why a significant decrease in incidence and/or mortality rates on the population level cannot be expected. The above-mentioned coverage rate is much lower than those of other screening programmes (for breast cancer and cervical cancer), both reporting coverage higher than 50%.

A further enhancement and optimisation of the current cancer screening programmes can be therefore considered as key priorities of the Czech National Cancer Control Programme [4].

Latest results of personalised invitations of Czech citizens to cancer screening programmes

In the period from January 2014 to December 2014, invitations were sent to more than 1.9 million Czech citizens. Over 596,000 women from the target population aged between 25 and 70 were invited to the cervical cancer screening programme. Invitations to breast cancer screening programmes were sent to more than 521,000 women aged 45 to 70. The largest number of people, however, were invited to participate in programme with the lowest coverage, the colorectal cancer screening programme: more than 1.5 million Czech men and women aged 50 to 70 (see Table 1). It should be mentioned here that the total number of invited persons is lower than a simple sum of number of persons invited to individual programmes, because many persons are invited to more than one cancer screening programme.

Table 2: Numbers of insured persons invited to individual cancer screening programmes during 2014 (invitations sent to a total of 1,959,504* persons).

Type of invitation letter Invitation to participate in
cervical cancer screening
breast cancer screening
colorectal cancer screening
Men invited to participate in colorectal cancer screening     783,151
Women invited to participate in cervical cancer screening 217,484    
Women invited to participate in breast cancer screening   126,962  
Women invited to participate in cervical and breast cancer screening 114,161 114,161  
Women invited to participate in colorectal cancer screening     391,152
Women invited to participate in cervical and colorectal cancer screening 46,350   46,350
Women invited to participate in breast and colorectal cancer screening   61,853 61,853
Women invited to participate in all cancer screening programmes 218,211 218,211 218,211
Total number of insured persons invited to cancer screening programmes 596,386 521,187 1,500,897

* The total number of invited persons does not correspond to the sum of numbers of invited persons to individual programmes, because many insured persons are invited to multiple programmes at the same time.

 

As for the target population for cervical cancer screening (almost 3.4 million Czech women aged 25 to 70), invitations were sent to 14.8% of eligible women during the evaluated period of nine months (January–September 2014). As for the target population for breast cancer screening (over 1.8 million Czech women aged over 45), invitations were sent to 23.9% of eligible women in the same period. A much more significant proportion of the eligible population was invited to colorectal cancer screening: invitations were sent to 44.1% of all eligible persons (a total of 2.8 million Czech citizens aged over 50). The participation rate in cancer screening programme varies with the clients’ age, and therefore different proportions of invited persons eligible for the programmes were reported in individual age groups. While only 7.2% of women aged 25 to 29 were invited to cervical cancer screening, almost a third (29.3%) of eligible women aged 65 to 70, whose participation rates are much lower, were invited to the same programme. As regards breast cancer screening, most invitations were sent to women aged 45 to 50; in this age, women are eligible for the first time to have a mammography of breasts reimbursed from the public health insurance. A similar result was reported for colorectal cancer screening, which is reimbursed from the public health insurance to men and women aged over 50. The coverage rate by invitations was higher in men.

Figure 1: Cervical cancer screening – coverage of the target population by invitation, according to sex and age. Invited persons in the period from January 2014 to September 2014, women aged 25 to 70, a total of 498,370 invitations. Source of data: Czech National Reference Centre.

Table 2: Response to invitation letter – participation rate of persons invited in the period from January 2014 to March 2014. Source of data: Czech National Reference Centre.

Screening programme
Number of persons invited
Participation rate (%)
for cervical cancer 209,018 8.1
for breast cancer 181,650 12.6
for colorectal cancer 525,225 14.2

Participation rates were evaluated only for cohorts of clients who had been invited in the period from January 2014 to March 2014, and their response to invitation (i.e., undergoing the screening test) was evaluated in the period from January 2014 to June 2014. In cervical cancer screening programme, where a relatively low proportion of women neglecting preventive check-up was invited, the participation rate was 8.1% (Tab. 2). Higher participation rates were observed in two other cancer screening programmes: namely, 12.6% in breast cancer screening, and 14.2% in colorectal cancer screening. However, age profiles of screened persons were rather different: whereas younger women (aged 45 to 49) attended breast cancer screening, older age groups responded better to invitations to colorectal cancer screening.

Figure 2: Cervical cancer screening – participation rates according to sex and age. Invited persons in the period from January 2014 to March 2014, women aged 25 to 70, a total of 209,018 invitations. Source of data: Czech National Reference Centre.

The first results have confirmed that the recently introduced system of personalised invitations is effective, and that there is a potential for a further increase in screening coverage in the years to come. To achieve this goal, however, a coordination of several important factors will be essential: in particular, strong management and organisation; high quality of all relevant health services; and, last but not least, willingness of the target population to participate in cancer screening programmes. A mutual harmony of these factors cannot be obtained without the support of health care authorities, policymakers, health insurance companies, and other involved parties.

References

  1. The Council of the European Union. Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC). Official Journal of the European Union 2003; L 327: p. 34–38.
  2. Miles A, Cockburn J, Smith RA, et al. A perspective from countries using organized screening programs. Cancer 2004; 101(5 Suppl): 1201–1213.
  3. Dušek L (Ed.). Czech Cancer Care in Numbers 2008–2009. Praha: Grada Publishing 2009, 496 s. ISBN 978-80-247-3244-2.
  4. National Cancer Control Programme of the Czech Republic [cited on 2015-02-17]. Available from WWW: http://www.onconet.cz/index-en.php?pg=national-cancer-control-programme--full-text

Related links

Last updated on 18 February 2015