Implementation of HPV based Cervical Cancer Screening Programme in Lithuania

Abstract

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.