HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia.

BACKGROUND: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. METHODS: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. RESULTS: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. CONCLUSIONS: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

Organised cervical cancer screening programme in the Belgrade municipality of Cukarica - Evaluation of process indicators.

PURPOSE: To evaluate the process indicators for monitoring the Organized Cervical Cancer Screening Programme (OCCSP) conducted in the Belgrade municipality of Cukarica within the first three-year interval, and to compare Pap test coverage for women aged 25 to 64 before and after implementing the organised programme. METHODS: We analyzed the coverage by invitation, compliance with invitation and coverage by Pap test for the first three-year interval of the OCCSP (20th Dec 2012 - 19th Dec 2015) as well as the results of opportunistic screening for the same period and coverage by Pap test for women aged 25 to 64 for the last three years prior to the implementation of the OCCSP. RESULTS: After the first three years of the OCCSP implementation, coverage by invitation was 42.9%, compliance to invitation 66.7% and coverage by Pap test was 28.6%. During the same period, outside of the program (opportunistic screening) coverage by Pap test was 9.4%. In the last three years prior to the implementation of the OCCSP coverage by Pap test for women aged 25 to 64 was 21.4%. CONCLUSION: After the first three-year interval of the OCCSP implementation, the overall (organised + opportunistic) Pap test coverage for women aged 25-64 has almost doubled compared to the period when we conducted exclusively opportunistic screening (38.4 vs 21.4%). However, incentive payment for the smear takers and better coordination and planning of capacity-building is needed in order to achieve the 75% Pap tests coverage recommended by the National Programme for Early Detection of Cervical Cancer.

New software for collecting data from the organized cervical cancer screening program in Serbia. Are we on the threshold of a new screening registry? - A multicentric study.

PURPOSE: The purpose of this study was to present the Screening Registry and the results of organized cervical cancer screening program (OCCSP) in the Republic of Serbia using a database made as an output model, linked with the Screening Registry. METHODS: Data were respectively collected over a onemonth period from 3 state primary health care centers (and related hospitals/clinical center) in central Serbia in which OCCSP was conducted. The sample consisted of women of the target population (25 to 64 years old) who responded the call for Pap test. RESULTS: The most frequent abnormal cytological diagnosis was in the 38-50 years age group, and consisted of atypical squamous cells of undetermined significance - ASCUS (7.5%) and low grade squamous intraepithelial lesions - L-SIL (7.3%). The most frequent abnormal colposcopic finding in the youngest age group of women (25-37 years) was iodine negative epithelium (35.7%) and in the group of women aged 38-50 and 51-64 years acid-white epithelium. The most common histopathological diagnosis was L-SIL. Positive predictive value of colposcopy in relation to the Pap test was 0.64 (95% CI=0.56-0.70). Interrater agreement (between cytotechnicians and supervisors) measured by the Cohen's coefficient was 0.94 (95% CI=0.91 to 0.97), but between cytology (supervisors) and pathology findings it was 0.83 (95% CI = 0.67 to 0.99). CONCLUSION: The existence of a screening registry contributes to a better epidemiological surveillance of a screening program, and to a possibility for development of various epidemiological researches.

Performance indicators collected from primary health centres included in organised cervical cancer screening programme in the Republic of Serbia.

PURPOSE: To present the performance indicators for monitoring the cervical cancer screening process conducted in primary health centres (PHCs) and to identify any shortcomings in the implementation of the Organized Cervical Cancer Screening Programme (OCCSP). METHODS: This study included 16 PHCs participating in the OCCSP in the Republic of Serbia. The data were analysed from the moment the methodology in the PHCs has been accurately and consistently applied in accordance with the European guidelines (earliest from 20th December 2012 until 30th November 2014). We constructed "the standardised" model (adjusted on the number of working months). Performance indicators analysed in this study were: coverage by invitation, coverage by examination, and compliance with invitation. RESULTS: According to "the standardised" model, coverage by invitation was 61.9%, coverage by examination was 35.5% and compliance to invitation was 57.3%. CONCLUSION: Social mobilization, education, effective promotion strategies and training about cervical cancer screening program-especially in women of target population-as well as better coordination and planning of capacity-building, and staff resources in PHCs, are needed in the future in order to obtain higher values for our performance indicators. Screening registration will provide additional information about demographic characteristics of the tested women.

Mortality from cervical cancer in Serbia in the period 1991-2011.

PURPOSE: The aim of this study was to analyze trends of death rates for cervical cancer (CC) on territory of The Republic of Serbia in the period 1991-2011. METHODS: In this descriptive epidemiological study, unpublished data of the Statistical Office of the Republic of Serbia were used for the analysis of mortality due to CC among women in Serbia, from 1991 to 2011. Three different types of rates were calculated: crude, age-specific and age-adjusted rates. The age-standardized rates were calculated by the direct method of standardization using the World Standard Population as standard. The trends were assessed by joinpoint linear regression analysis. An average annual percentage change (AAPC) and the corresponding 95% confidence intervals (CI) were computed for trends. RESULTS: The average age-standardized CC mortality rate (ASCCMR) was 7.03 per 100,000. The lowest value of the ASCCMR was at the beginning of the observed period (6.05 per 100,000) and the highest was 8.17 per 100,000 in 2008. The age-adjusted CC mortality rates have been continuously and significantly increasing (AAPC=+0.7, 95% CI=0.3- 1.1, p<0.05). In all age groups we found increasing trends, except in the age group of 65-74 years. CONCLUSION: Since ASCCMR has been steadily increasing during the period observed, reducing these rates is highly warranted. To achieve this target, an organized CC screening program is essential.

Alcoholic liver disease/nonalcoholic fatty liver disease index: distinguishing alcoholic from nonalcoholic fatty liver disease.

OBJECTIVE: The alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) (ANI) scoring system was constructed as a response to a clinical need for avoiding the risks of liver biopsy in diagnosing the etiology of fatty liver disease. The aim of this study was to test the reliability of ANI as a noninvasive method to distinguish ALD from NAFLD. MATERIALS AND METHODS: One hundred and thirty-five patients were classified into two groups, ALD and NAFLD, according to the pathohistological results. Parameters for ANI are aspartate aminotransferase, alanine aminotransferase, mean corpuscular volume, BMI, and sex. ANI was calculated using an online calculator, official site of Mayo Clinic. RESULTS: ANI was significantly higher in patients with ALD than NAFLD (P<0.01). The cutoff point of ANI is -0.66. ANI greater than -0.66 indicates ALD, whereas ANI less than -0.66 yields a higher probability of NAFLD with high specificity (96.7%) and sensitivity (84.1%). The mean corpuscular volume and aspartate aminotransferase/alanine aminotransferase ratio were higher, whereas BMI was lower in patients with ALD than in NAFLD (P<0.01). CONCLUSION: The ANI scoring system may be used for the estimation of alcoholic origin of steatosis/steatohepatitis and may help in triaging patients for liver biopsy. ANI less than -0.66 indicates NAFLD, whereas ANI greater than -0.66 confirms the alcoholic etiology, but does not exclude the contribution of associated factors toward the development of fatty liver in a Serbian population.

Increasing incidence of rubella in Republika Srpska in the period 2006-2010.

The aim of this study was to investigate the incidence rate of rubella in Republika Srpska in the period between 2006 and 2010. The total number of 1236 cases of rubella was reported during the reporting period with manifold increasing incidence from 0.5 in 2006 to 54.7 in 2010 per 100,000 habitants. In the last two years of observation there was a disease outbreak in Republika Srpska. Inadequate immunization, migration and lack of funds caused a reduction in the overall level of public health and health system which led to a drastic increase in the number of rubella cases.

Evaluation of health-related quality of life in patients with prostate cancer after treatment with radical retropubic prostatectomy and permanent prostate brachytherapy.

AIM: The aims of this study were to evaluate the health-related quality of life (HRQOL) and make the treatment decision less difficult. METHODS: Between 2007 and 2009 radical retropubic prostatectomy (RRP) was performed in 96 patients and permanent prostate brachytherapy (PPB) in 88 patients at our hospital. The general and disease-specific HRQOL was measured using two instruments, the Medical Outcome Study 8-Item Short-Form Health Survey (SF-8) and the expanded prostate index composite (EPIC). RESULTS: Comparing RRP and PPB, there were significant differences in all scores except for general health in the 1st month after treatment which had the same score in both groups. The baseline quality of life scores in physical function (p < 0.05), physical role (p < 0.01), social functioning (p < 0.01), emotional role (p < 0.01) and mental health (p < 0.01) showed significant differences between the group and were better in the PPB group than in the RRP group. The physical component summary score in the PPB group was better than in the RRP group in the 1st month (p < 0.01) but recovered up to 3 months in the RRP group. The urinary bother and irritative/obstructive scores in the 1st month were worse from baseline in both groups (p < 0.05) and remained significantly worse up to 6 months in the PPB group than in the RRP group where these scores recovered within 3 months. The urinary incontinence score in the RRP group was still worse than in the PPB group up to 12 months (p < 0.01). Bowel function and bother were significantly better in the RRP group at 3 (p < 0.05) and 6 months (p < 0.01) than in the PPB group where bowel function at 12 months was worse than at baseline and in the RRP group. Sexual function (p < 0.01) and sexual bother were better in the PPB group and did not change until 12 months. CONCLUSION: The difference in disease-specific quality of life has become clearer using EPIC. As with other published studies, our results provide important information that will therefore be useful for selecting the optimal treatments for localized prostate cancer.