CERVICAL CANCER SCREENING IN SPLIT DALMATIA COUNTY FROM 2013th TO 2015th

Cilj istraživanja. Cilj ovog istraživanja bio je utvrditi udio Papa testova analiziranih u sklopu organiziranog Nacionalnog probira za rak vrata maternice, procijeniti adekvatnost uzorka te udio abnormalnih nalaza. Ispitanice i metode. U istraživanje uključeno je 4 099 žena s područja Splitsko – dalmatinske županije, čiji su uzorci Papa testa uzeti u sklopu Nacionalnog probira za karcinom vrata maternice, u razdoblju od 01.01.2013. do 31.12.2015.g. Uzorci su bojeni metodom po Papanicolaou i analizirani prema kriterijima Bethesda sustava. Rezultati. U samo 6,1% žena Splitsko – dalmatinske županije, Papa test uzet je u sklopu organiziranog Nacionalnog probira. Adekvatno za citomorfološku analizu bilo je 64% uzoraka Papa testa. Samo 11 uzoraka nije analizirano zbog izrazite oskudnosti uzorka ili tehničkih razloga. U skupini žena sa suboptimalnim uzorkom (36%), najčešći razlog bio je nedostatak stanica transformacijske zone, što stavlja ove žene u rizičnu skupinu s potencijalno lažno negativnim nalazom Papa testa. U skupini suboptimalnih uzoraka, na drugom su mjestu uzorci prekriveni upalnim stanicama, što otežava morfološku analizu razmaza. Među analiziranim uzorcima Papa testa, u samo 53 uzorka (1%) nađene su abnormalne stanice. Najbrojniju skupinu abnormalnih nalaza čine atipične pločaste stanice neodređenog značenja – ASCUS (34%). U ovom istraživanju, među Papa testovima uzetim u sklopu organiziranog probira nije dijagnosticiran niti jedan invazivni rak pločastog ili žljezdanog epitela. U 12 žena dijagnosticirana je intraepitelna lezija visokog gradusa (HSIL i ASC-H). Zaključak. Probir za rak vrata maternice ima za cilj otkriti pretkliničku bolest relativno jeftinim testom, kao što je Papa test, te smanjiti učestalost invazivne bolesti i smrtnost. Premali udio žena uključenih u organizirani probir i nemogućnost praćenja, slabe su točke organiziranog probira u našoj županiji. Dobra organizacija, definirani nacionalni standardi osiguranja i kontrole kvalitete probira te praćenje indikatora probira ključevi su uspješno organiziranog Nacionalnog probira.Background. The aim of this study was to determine the proportion of Pap tests analyzed as the part of the National organized screening program for cervical cancer, assess the adequacy of the sample and the proportion of abnormal findings. Methods. The study included 4,099 women from the area of the Split Dalmatian County. Pap smears were taken as the part of the National screening program for cervical cancer between 01.01.2013. and 31.12.2015. The samples were stained by the Papanicolaou methods and analyzed according to the criteria of Bethesda classification system. Results. Only 6.1% of Pap smears were taken as the part of the National Organized screening program for cervical cancer in our County. Adequate for cytomorphologic analysis were 64% of the analyzed samples. Only eleven samples were not analyzed because of the extreme scarcity or technical reasons. The lack of the transformation zone cells were the most common reason of the suboptimal samples (36%), which increses the risk of a potentially false negative Pap test results. In the suboptimal category were also the samples covered with inflammatory cells, making the cytomorphological analysis difficult. Among the analysed samples we have found only 53 abnormal samples (1%). The most common category of the abnormal report were the Atypical cells of undetermined significance - ASCUS (34%). We have not found any sample with invasive squamous or glandular carcinoma but we have found twelve high grade intraepithelial lesions (HSIL and ASC-H). Conclusion. Screening for cancer consists of the identification of preclinical disease by a relatively simple test. The reduction in the incidence of the invasive disease and the risk of death is objective of organized screening. We indicate the low coverage and the lack of adequate follow-up of normal and abnormal samples as the weak spots in the organized national cervical cancer screening program in our County. The key for success of National screening programme is organisation, existence of national standards for quality assurance and control and constant monitoring of short- and long term indicators