Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study.

OBJECTIVES: Cervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC. STUDY DESIGN: This was a nationwide population-based retrospective study. METHODS: Data on CC cases diagnosed in Estonia in 2007-2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II-IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005-2019 were examined with joinpoint analysis. RESULTS: Incidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007-2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007-2009 to 58% in 2015-2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87-2.49 for women aged ≥75 years compared with those aged 30-44 years), educational level (PR 1.32, 95% CI 1.15-1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01-1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality. CONCLUSIONS: To reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women.

European consensus statement on expert colposcopy.

BACKGROUND: Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS: To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS: Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION: The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.