Ivanauskienė, Rugilė

Background/Objectives: Cervical cancer incidence and mortality in Lithuania remain among the highest in the EU (18.3 and 11.0 per 100,000 women in 2022, versus EU averages of 11.7 and 5.3). The national screening program, implemented since 2004, shifted from primary screening with cytology for women aged 30 – 60 to primary screening with cytology for women 25-34 and High-Risk Human Papillomavirus (HR HPV) -based screening for women 35 – 60 in 2022. This study aims to present the overview of the implementation status of national organized cervical cancer screening programme, based on HR HPV primary testing in Lithuania. Methods: We reviewed relevant ongoing national processes, documents and available national data to assess the implementation status and early preliminary results of national HR HPV based cervical cancer screening program in Lithuania. The organizational and methodological updates were revealed through the analysis of national legislative documents, the overview of other cancer screening programme elements were revealed from National cervical cancer screening methodology guidance group and the quantitative data was analyzed using specific cervical cancer screening subsystem in National Data Agency platform. Results: The national cervical cancer screening program in Lithuania has been implemented since July 2004. First cytology-based screening was offered to women aged 30–60 years every 3 years. During these years the programme was updated several times, and recently the country has implemented HR HPV based screening for women 35-60 years old, leaving conventional cytology (CT) based screening for women aged 25–34 years. The HR HPV based screening includes primary testing with HR HPV, triage test – liquid based cytology, follow-up HR HPV test in 12 months for HR HPV positives and cytology negatives and direct referral for colposcopy for women with HR HPV positive results and cytology ≥ASCUS. National updates of the programme included preparation and legislation of national quality assurance guidelines, fully organized programme coordination and management as well as renewal of E-health system with electronic data forms for screening. The assessment of key performance indicators for 2024 revealed that the test coverage rate was 54.27% among women aged 25–34 years tested with CT and 96.56% among women aged 35–59 years tested with HR HPV. The response-to-invitation rate was 36.32% among women aged 25–34 years tested with CT and 41.73% among women aged 35–59 years tested with HR HPV. Conclusions: Lithuania has implemented evidence-based changes in national cervical cancer screening programme. HR HPV based screening strategy preliminary demonstrates high coverage rates, but further analysis is needed to clarify whether such results are related to screening method (HR HPV) or to better response from older age group of the programme population.

Ši mokomoji knyga yra skiriama Lietuvos sveikatos mokslų universiteto studentams, kurie studijuoja fundamentinę epidemiologiją. Leidinyje pateiktos užduotys ir klausimai turėtų padėti besimokantiems geriau suvokti pagrindines fundamentinės epidemiologijos sąvokas ir koncepcijas bei žinoti jų pritaikymą praktikoje. Tikimės, kad ši mokomoji knyga padės sudominti studentus epidemiologijos teorija bei praktika ir leis plačiau suprasti populiacinių tyrimų svarbą medicinos ir visuomenės sveikatos mokslų srityse.

Ši mokomoji knyga yra skiriama Lietuvos sveikatos mokslų universiteto studentams, kurie studijuoja fundamentinę epidemiologiją. Leidinyje pateiktos užduotys ir klausimai turėtų padėti besimokantiems geriau suvokti pagrindines fundamentinės epidemiologijos sąvokas ir koncepcijas bei žinoti jų pritaikymą praktikoje. Tikimės, kad ši mokomoji knyga padės sudominti studentus epidemiologijos teorija bei praktika ir leis plačiau suprasti populiacinių tyrimų svarbą medicinos ir visuomenės sveikatos mokslų srityse.

Background The EU Cancer Mission has set the goal to improve the lives of more than 3 million people by 2030 through prevention, cure and for those affected by cancer including their families, to live longer and better [1]. To learn about what citizens find important, a series of focus groups were organised with citizens in six EU Member States: Bulgaria, Czechia, Finland, France, Lithuania, and Malta. The focus groups concerned discussions about cancer awareness, prevention, early detection, and screening. Perceptions regarding cancer The focus groups indicated that cancer was perceived as a frightening disease that could happen to anyone. The fear of a cancer diagnosis and the taboo associated with some cancers could prohibit people to visiting or contacting a doctor. The group was suggested to explain that cancer is not a death sentence and to inform people on what could help prevent cancer. Perceptions regarding the prevention of cancer Participants indicated that healthcare professionals are a key source of information. They also emphasised the importance of education about cancer risks and prevention as part of the school curriculum and addressed the importance of accessible and reliable information. Campaigns should express hope and focus on what to do to prevent cancer. Several cancer risk factors were discussed, including sun exposure, tobacco, alcohol, environmental factors, diet, physical activity, and stress. Participants referred to a lack of awareness on how these factors can cause cancer and on how to change their behaviour to avoid exposure to risks and promote a healthier lifestyle. Several participants also discussed the risk of developing cancer due to a hereditary predisposition, despite a healthy lifestyle. Perceptions regarding early detection and screening Participants were largely aware of the importance of checking and monitoring one’s body to detect any changes. Most participants were also aware of screening programmes to detect cancer at an early stage. Reasons for not participating in screening programs, included shame in discussing irregularities and the fear of being diagnosed with cancer. Another barrier was the distance to screening centres for people in remote areas. It was suggested to offer mobile screening facilities, and/or to include cancer screening via general and occupational health practitioners. Participants also mentioned that better information on screening programs is needed to increase participation rates. Information should enhance the understanding of screening and what a screening test entails. Health professionals have an important role to play to better informing citizens on screening programs and to promote open discussions to reduce shame and fear. Still, governments were considered to be the main source of information, for instance via (social media) campaigns. Main recommendations The insights from this study, although based on focus groups with a limited number of EU citizens, underline the importance of improving information and communication on cancer prevention and early detection and screening for EU citizens. More and better actions are needed to address barriers and support citizens in preventing cancer, with actions and initiatives that consider different levels of motivation and beliefs of the population and the wide array of aspects that could hinder preventive and early detection measures.

Introduction Antimicrobial resistance (AMR) is a significant threat to humans, animals and the environment, demanding urgent and coordinated efforts for mitigation. Education of healthcare workers (HCWs) is a key strategy for improving prescribing and reducing AMR promoting practices in human healthcare settings. Education of healthcare workers should, therefore, be considered a priority for national and international policy makers, including within the EU. Rationale The EU aims to enhance antimicrobial stewardship and considers education of healthcare professionals as a key component within the Council recommendation Stepping up EU actions to combat antimicrobial resistance in a One Health approach1. Current evidence from the ECDC suggests that Greece, Hungary and Italy have the lowest rates of knowledge on AMR amongst healthcare workers2. This report aims to outline key areas to enhance education within these countries and the EU, in order to improve the standard of AMR management across the European region. Key findings ● Current AMR education lacks the integration of One Health approaches in general healthcare education at all levels, from undergraduate to postgraduate and continuing education. ● AMR continues to be a growing problem within the target countries (Greece, Hungary, Italy, Lithuania, Portugal, Spain), with a need to enhance all AMR stewardship interventions. ● The implementation of educational aspects of the AMR national action plans is currently low, and requires concerted effort, including resource mobilisation. ● The target countries currently lack standardised national education for healthcare professionals on recommended topics for AMR education. This issue exists within undergraduate, postgraduate and continuous education and requires systematic action to improve this. ● There are disparities in educational availability on AMR across the various healthcare workers. Efforts to address health professionals such as pharmacists, nurses, and laboratory technicians remain spontaneous and rely heavily on on-the-job experience. [...] Conclusion Although significant achievements have been made in the development of education for AMR, within the countries discussed there is a need for strategic educational development for all healthcare professionals to achieve universal improvements in knowledge. AMR requires cross-border responses and AMR education for healthcare professionals is a key component of achieving antimicrobial stewardship and protecting modern medicine.

The CanScreen5 project is a global cancer screening data repository that aims to report the status and performance of breast, cervical and colorectal cancer screening programs using a harmonized set of criteria and indicators. Data collected mainly from the Ministry of Health in each country underwent quality validation and ultimately became publicly available through a Web-based portal. Until September 2022, 84 participating countries reported data for breast (n = 57), cervical (n = 75) or colorectal (n = 51) cancer screening programs in the repository. Substantial heterogeneity was observed regarding program organization and performance. Reported screening coverage ranged from 1.7% (Bangladesh) to 85.5% (England, United Kingdom) for breast cancer, from 2.1% (Côte d'Ivoire) to 86.3% (Sweden) for cervical cancer, and from 0.6% (Hungary) to 64.5% (the Netherlands) for colorectal cancer screening programs. Large variability was observed regarding compliance to further assessment of screening programs and detection rates reported for precancers and cancers. A concern is lack of data to estimate performance indicators across the screening continuum. This underscores the need for programs to incorporate quality assurance protocols supported by robust information systems. Program organization requires improvement in resource-limited settings, where screening is likely to be resource-stratified and tailored to country-specific situations.

2022 m. ES Taryba patvirtino naujas onkologinių ligų populiacinės patikros rekomendacijas, siekiant sumažinti išvengiamų onkologinių ligų naštą. Viena iš svarbiausių žinučių šiame dokumente yra skirta patikros programos apimčių didinimui - siekiama, kad iki 2025 m. ne mažiau kaip 90 proc. tikslinių populiacijų gyventojų gautų kvietimą pasitikrinti ir sudalyvauti patikros programose. Gimdos kaklelio vėžio patikros programos temoje yra numatytos tokios svarbiausios priemonės: AR ŽPV patikros ir tikslinamojo tyrimo įdiegimas, savarankiškai paimamų ŽPV mėginių naudojimas, ŽPV vakcinacijos apimčių didinimas, programos vykdymas pagal kokybės užtikrinimo reikalavimus. Lietuvoje yra įgyvendinami onkologinių ligų patikros programų efektyvumo gerinimo pokyčiai - įsteigti patikros programų koordinavimo centrai (Lietuvos sveikatos mokslų universiteto ligoninė Kauno klinikos ir Vilniaus universiteto ligoninė Santaros klinikos), parengtos nacionalinės onkologinių ligų patikros programų vykdymo kokybės užtikrinimo rekomendacijos, kuriamas skaitmeninis patikros programų registras. Tikimasi, kad šios priemonės leis padidinti populiacinių patikros programų efektyvumą ir sumažinti šių ligų epidemiologinius rodiklius.

Gimdos kaklelio vėžio profilaktinė patikros programa moterims Lietuvoje yra vykdoma nuo 2004 m. Nepaisant šios aplinkybės, epidemiologinė gimdos kaklelio vėžio situacija per 20 m. pakito labai nežymiai, o Lietuva vis dar fiksuoja vienus iš didžiausių sergamumo (18.7 atv. 100 000) ir mirtingumo (6,7 atv. 100 000) rodiklių Europoje. Pagrindinės efektyviausios šios ligos kontrolės priemonės yra ŽPV vakcinacija, citologinio tyrimu ir AR ŽPV tyrimu grįsta populiacinė patikros programa. Tarptautinių tyrimų duomenimis, Lietuva patiria iššūkių šiuose programos įgyvendinimo procesuose: nepakankamas moterų dalyvavimas programoje, nepakankamas dėmesys komunikacijai, kokybės kontrolei bei programos stebėsenai. Lietuvoje pastaraisiais metais įgyvendinami nacionaliniai projektai siekia išspręsti šias problemas - sukurti efektyvesnį gimdos kaklelio patikros programos koordinavimą, sukurti ir įdiegti skaitmenizuotą patikros registrą, užtikrinantį individo lygmens duomenų pateikimą ir programos stebėseną bei vertinimą.

Vėžys yra liga, kurią sukelia nekontroliuojamas ląstelių augimas. Kiekviena onkologinė liga turi specifinius rizikos veiksnius, diagnostiką, gydymą ir profilaktiką. Prognozuojama, kad 2020 m. Jungtinėse Amerikos Valstijose bus diagnozuota 1 806 590 naujų vėžio atvejų ir teigiama, kad galima išvengti 42 proc. vėžinių ligų koreguojant rizikos veiksnius, šiame moksliniame tyrime apžvelgiamos naujausios profilaktikos priemonės onkologinių ligų prevencijai.

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.