Population screening program for cancer of the cervix: the spearhead of the National Action Plan for Cancer 2011–2015

The prevention and management of chronic non-communicable diseases, and cancer in particular, has been a priority for the Ministry of Health and Social Solidarity.

A year ago, on 16 December 2010, the Minister Mr A. Loverdos, the Deputy Minister Mr M. Timosidis and the General Secretary of Public Health Mr A. Dimopoulos presented the National Action Plan for Cancer 2011–2015 and launched a public consultation for this major issue. One year after its launch, we are able to present the first concrete results.

The National Action Plan for Cancer 2011–2015 is an integrated set of activities covering all aspects of cancer treatment, with dominant values emphasizing the importance of prevention and early diagnosis and treatment of the disease, as well as ensuring uniform, fair, scientifically sound and high-quality health care.

Special attention is given to prevention and early diagnosis of the most common cancers. The first major intervention has been to organize a national cervical cancer screening program. This program represents the first organized effort in our country to develop a comprehensive system of care, referral, treatment, testing and retesting for a disease and specifically for a type of cancer (cervical) that is a major public issue. Similar programs for the most common cancers are implemented at a national level in only few highly developed countries (Nordic countries and the United Kingdom), reflecting the difficulty of the project, which is hindered during the economic crisis.

A working group functioned to design the program; its members worked voluntarily and have undertaken the development of the program’s guidelines according to the respective European guidelines, and approved the pilot information system that will be launched in this first phase. The working group leader was Professor Ch. Lionis and members of the group were Professors P. Karakitsos, E. Paraskevaidis and G. Panagiotidis, as well as managers of the national health system (NHS) and specialists in pathology, epidemiology, health services and public administration.

Monitoring of the implementation is being carried out by the General Secretariat of Public Health. The implementation involves 140 primary health centers and dispensaries, 160 municipalities and all NHS hospitals where cytology and pathology laboratories (including those that perform colposcopy) operate. The program was launched on 1 July 2011 in the region of Sfakia in Crete, and was gradually extended throughout the country until October 2011. The design of the project, followed by the General Secretariat of Public Health, was based on the instructions of the working group, as follows.

  • The municipalities’ social services send invitation letters to women aged 25–65 to motivate them to make an appointment for a Pap test at the nearest primary health care unit, NHS health center or community health center.
  • The invitation letter will be sent every 3 years to women aged 25–55 and to women aged 55–65 with abnormal Pap smears. For women aged 55–65 with negative Pap test results, the invitation letter will be sent every 5 years.
  • The first phase of the national program was implemented in remote areas and/or areas disadvantaged in accessing health services.
  • Women who should be under treatment or have further diagnostic tests are referred to the nearest NHS hospital for the appropriate health services.
  • After completing the approval process from the Association of Personal Data Protection, an integrated information system will operate via a web application, where the Pap tests results will be recorded to monitor the progress of women with abnormal findings and to facilitate prompt follow-up care.
  • Assessment, assurance and continuous quality improvement are also provided.

The first results are extremely positive. Specifically, compared with the last year’s corresponding months, there was an increase in the number of women tested at the respective health centers of 60.31% in August, 53.2% in September, 55.07% in October, 78.84% in November and 128.73% in December 2011!

The implementation of the program has allowed the detection of severe pre-malignant lesions in many women who have been treated in accordance with good medical practice via the NHS. In particular, during the first 5 months of the program’s inception, 17 cases of cervical cancer and 121 cases of women with severe pre-cancerous lesions were diagnosed. Furthermore, 180 women were referred for biopsy and 439 women for colposcopy. Up to now, a total number of 19,292 women has been seen at the health centers.

It is worth noting that the program is supported solely by current employees without extending their standard working hours and without receiving extra pay, and is implemented within the available infrastructure of the NHS.

Based on our initial review of the plan, co-operation between the municipalities and health centers has improved; the NHS is more effective and efficient, and we are also strengthening the public primary health care and its ties with the community.

Other important activities regarding cancer are as follows.

  1. In the coming months, a national population screening program for breast cancer will be launched.
  2. We are making progress in implementing a national cancer registry in Greece. By late 2013, Greece will have a valuable tool for the epidemiologic study of cancer, as well as for increasing the effectiveness of our intervention against cancer, which will be linked to a health map and reference networks.
  3. We have introduced protocols and guidelines in clinical practice. Prescription protocols for cancer patients have already been completed and approved by the central board of health, which includes all procedures and treatments related to the fight against cancer. We have developed and integrated all clinical protocols and guidelines for the main types of cancer. The expected benefits of the introduction of protocols in clinical practice are improvement in the quality of care and the achievement of greater equality and cost control.
  4. A review of oncologic boards and committees for oncology hospitals is in progress. This is a necessary action to ensure the effective implementation of the policy, improving care and controlling costs.
  5. Furthermore, we are organizing oncology networks (one per health district). The oncology network will consist of all NHS structures (health centers, general and specialist university hospitals and cancer hospitals). Our goals is to co-ordinate the fight against cancer better, monitor the implementation of our policy and support all health structures with specialized scientific knowledge.
  6. In the coming months, the procurement process of appropriate biomedical equipment technology (in our hospitals) costing 69 million euros will be completed.
  7. With regard to the creation of respite centers, recently a center for ambulatory patients in Pilea, Thessaloniki, has been opened with a capacity of 100 beds, which operates under the supervision of ‘Theageneio’ cancer hospital. Additionally, in collaboration with the Church of Greece and other governing bodies, we will make further centers available (e.g. hospices for final-stage patients and their carers in ‘Sotiria’ hospital).
  8. Finally, we are integrating pain clinics within hospitals, institutional settings for home care and implementing training programs for health care professionals and the public.

For more details and information please visit the webpage of the National Action Plan for Cancer http://www.anticancer.gov.gr/.

Send your ideas and suggestions to the following e-mail address: anticancer@yyka.gov.gr

With the National Action Plan we will mobilize the forces of our country in the fight against cancer.

We emphasize prevention and early diagnosis; we organize treatment; we invest in research and education.

 

Aristomenis Syggelakis, Deputy Director of the 1st health region of Attica, Head of the National Action Plan for Cancer 2011–2015