Incidence of Cervical Intraepithelial Neoplasia in Estonia

Uusküla, Anneli; Raag, Mait; Uppin, Arno; Raud, Terje; Klaar, Ursula; Jürisson, Mikk; Müürsepp, Andres

doi:10.1097/lgt.0b013e3182652213

Cited by 5 publications

(3 citation statements)

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“…Given our findings, there is a clear need to improve CC screening attendance among women in Estonia. We did not assess the performance of the Pap test in our study, but there are indirect indications of significant under-detection/diagnosis of CIN2+ in Estonia [25]. However, we support the idea of seeking and testing new innovative interventions to improve programme uptake through interventions such as self-sampling and electronic reminders [26], as well as changing CC test screening to HPV DNA.…”

Section: Discussionmentioning

confidence: 59%

Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study

et al. 2021

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Background The World Health Organisation (WHO) calls for the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing, and dying from, CC over the general population. Estimates of cervical cancer screening programme coverage in Eastern European countries that have experienced HIV epidemics since the early 2000’s are scarce. Method This population-based retrospective study uses a healthcare administrative database and follows cohorts of all WLWH in a ratio of 1:3 randomly matched (age, region) HIV negative women from 2009 to 2018. Annual and longitudinal (over the whole study period) coverage for cervical cancer screening (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009 to 2018. Results Among WLWH and HIV-negative women, the mean annual coverage with opportunistic screening was 61.45 and 65.59%; and organised screening was 20.4 and 28.7%, respectively (both: p < 0.00001). 19.01% (95% CI 18.05–19.97) HIV-negative and 13.9% (95% CI 12.35–15.45) WLWH were longitudinally covered with organised cervical cancer screening. Among WLWH, the mean annual HIV-specific cervical cancer screening coverage was 49.4, and 24.3% were longitudinally covered. Longitudinal coverage with HIV-specific cervical cancer screening was inversely associated with age, hepatitis C virus (HCV) co-infection (AOR 0.754, 95% CI 0.619, 0.916), not having insurance (AOR 0.331, 95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95% CI 0.336, 0.618) and higher among those retained in HIV care (AOR 1.972, 95% CI 1.615, 2.410). Among HIV-negative women, longitudinal coverage with organised cervical cancer screening was inversely associated with residence in the region and higher among older women. Conclusions Our results highlight unacceptably low coverage of cervical cancer screening of WLWH in Estonia. There is need for dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.

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Section: Discussionmentioning

confidence: 59%

Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study

et al. 2021

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“…We did not assess the performance of Pap test in our study, but there are indirect indications of signi cant under-detection/diagnosis of CIN2+ in Estonia. [30] However, we support the idea of seeking and testing new innovative interventions to improve program uptake through interventions like self-sampling and electronical [30] reminders as well as changing CC test for screening to HPV DNA.…”

Section: Discussionmentioning

confidence: 74%

Cervical Cancer Screening Patterns Among HIV-positive Women in Estonia: A Population Based Retrospective Cohort Study

Tisler

OJAVEE²,

Veerus

et al. 2020

Preprint

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IntroductionThe World Health Organisation (WHO) calls fot the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing and dying from CC over the general population. Estimates of cervical cancer screening (CCS) program coverage in Eastern European countries that have experienced HIV epidemics since early 2000s are scarce. MethodsThis population-based retrospective study uses healthcare administrative database and follows cohorts of all WLWH and in a ratio 1:3 randomly matched (age, region) HIV negative women from 2009-2018. Annual and longitudinal (over the whole study period) coverage for CCS (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009-2018.ResultsAmong WLWH and HIV negative women, the mean annual coverage with opportunistic screening was 61.45%, and 65.59%; organised screening 20.4%, and 28.7%, respectively (both: p<0.00001). 19.01% (95% CI 18.05-19.97) HIV negative and 13.9% (95% CI 12.35-15.45) WLWH were longitudinally covered with organised CCS. Among WLWH, the mean annual HIV specific CCS coverage was 49.4 % and 24.3% were longitudinally covered. Longitudinal coverage with HIV specific CCS was inversely associated with age, HCV co-infection AOR 0.754 (95% CI 0.619, 0.916), not having insurance AOR 0.331 (95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95%CI 0.336, 0.618) and higher among those retained in HIV care AOR 1.972 (95% CI 1.615, 2.410). Among HIV negative women, longitudinal coverage with organised CCS was inversely associated with residence region and higher among older women. ConclusionsOur results highlight unacceptably low coverage of WLWH with cervical cancer screening in Estonia. There is a need for a dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.

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“…In this period, the total number of L-SIL and H-SIL (Pap III) findings amounted to 395 (6.20%) compared to other cytological findings 5894 (92.44%). Uusküla A. et al (14), in their study, “Incidence of cervical intraepithelial neoplasia in Estonia” stated that the incidence of CIN on 1,000 women is in the range from 0.68 to 2.83 for CIN I, from 0.63 to 1.24 for CIN II and from 0.13 to 0.53 for CIN III.…”

Section: Discussionmentioning

confidence: 99%

Frequency of L-sil and H-sil Findings in Hpv Positive Women

2014

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Introduction:Cervical carcinoma is one of the leading health issues for women throughout the world. In 90% of the cases cervical carcinoma develops after development of invasive lesions of the uterine cervix or 10-15 years before they are diagnosed using cytological screening–Papanicolau test. Infection with human papilloma virus is considered to be the basic etiological cause of development of CIN and cervical carcinoma.Goal:Of this research was to determine frequency and type of abnormal cytological results in HPV positive and HPV negative patients.Material and Methods:Research is descriptive analytical, comparative and partly epidemiological, of mostly clinically applicable character. Used data included information on total number of examinations, type of exam, results of cytological and pathohistological diagnostics, HPV findings in cervix smear and HPV type in the period between January 1, 2009 and December 31, 2011.Results:During the period of analysis total number of Pap tests was 6376 (43.33%), in comparison to other exams 7828 (56.67%). For this period total number of L-SIL and H-SIL (PAPA III) was 395 (6.20%), in comparison to other results 5894 (92.44%). After analysis largest subset of HPV positive patients had pathohistological diagnosis of CIN I that is 250 (43.10%) of them, then CIN II with 162 (27.93%) patients, CIN III with 149 (25.69) and 3 (0.52%) patients had CIS while 16 (2.76%) had a clear test result. We can conclude there is a statistically significant margin of frequency between positive HPV results in relation to diagnosis. Highest percentage of L-SIL and H-SIL (PAPA III) test results was in 2010 and was 9.5%, and lowest in 2009 with 4.34%. Largest number of patients, 43.0%, with HPV positive results after cervical smear had pathohistological diagnosis of CIN I.

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Incidence of Cervical Intraepithelial Neoplasia in Estonia

Abstract: Our estimates for cervical dysplasia disease frequency and age distribution are in line with those from other developed countries. Administrative health care resources (such as health insurance fund data) are a valuable source for health research.

Cited by 5 publications

References 25 publications

Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study

Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study

Cervical Cancer Screening Patterns Among HIV-positive Women in Estonia: A Population Based Retrospective Cohort Study

Frequency of L-sil and H-sil Findings in Hpv Positive Women

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