Lecture on mandatory screening in prevention of cancer (summary of the lecture)

On 26 April 2014 SUPRAM hosted a lecture titled ‘Introduction of the organized screening in Serbia and activities of implementation of the National program for cancer prevention”. The lecture was given by dr Snežana Žujković, specialist gynecologist-obstetrition, chief of the department for pathology of pregnancy of the Hospital for gynecology and obstetrics of KBC Zemun, accredited supervisor for intepretation of Pap smears in Screening and national coordinator for cervix of the project „Support to the introduction of the National program for early detection of cancer in Serbia“ and dr Verica Jovanović, chief of the Office for cancer screening of the Institute for public health of Serbia „Dr Milan Jovanović Batut“, master of Management in health and specialist in social medicine.

Dr Žujković emphasised to the importance of introduction of the organised cancer screening in Serbia, having in mind that Serbia is on 29th place in cancer morbidity and on second place in Europe in cancer mortality, after Hungary. Slovenia and Hungary initiated organised screening in 2003. In Serbia is currently conducted oportunistic screening of cancer. For the purpose of organised screening, there is a need for more financial resources, better IT network, existence of screening register, educated HR, good diagnostic capacities, permanent inflow of tests, quality controle, existing strategy. Well organised screening is the one encompassing over 70% of inhabitants. Screening is turnover from reactive medicine to preventive medicine. Dr Žujković emphasised that basic steps in screening are: determination of target groups, testing, determination the frequency of screening, triage, treatment, monitoring, quality control. Organised screening of cervix is conducted every 3 to 5 years, of breasts and colon every two years. Project „Support to the introduction of the National program for early detection of cancer in Serbia“ prepared three clinical pathways for three sorts of screening. Dr Žujković emphasised that there were several successfull projects related to screening in Serbia. One of the is Branicevo project, which was the basis for drafting the National program for early detection of cancer in Serbia. The successes related to screening is that National guidelines for screening are enacted, the Screening Office is established, project trained cca. 1000 health profesionals in this area, the quality controle is introduced through thesting of physicians.

Dr Verica Jovanović pointed out that in 2013. the Screening office is established (Decree from 16th of August-Official gazette RS, no. 73/2013). Employees in the office are support to the collegues which implment organised screening in the field. Participants in screening are all health institutions and private practice. The main bearers of the organised screening are primary health care centres as the „gate keepers“ and as the entities having the best organised list of patients/citisens. Osnovni nosioci organizovanog skrininga su domovi zdravlja kao „čuvari kapije“ i kao oni koji imaju najbolji popis pacijenata/gradjana. Hospitals do the additional diagnostics and additional checks (quality control). Dr Jovanovic emphasises that the age of the invited people is important in all three sorts of screening. In breast screening these are woment between 50 and 69. Breast screening is mamography. Bearer of screening is gynecologist. Interpretation of the results is done by two radiologists. Dr Jovanovic listed the data from the end 2013., according to which 12 municipalityes participated in breast screening. 26 primary health care centres shall be included in 2014. In breast screening mobile mamographs were very succesful. These mamographs were donated by B92 and Pricess Katharina foundation. In 2013 150 breast cancers were diagnosed. When cervix is concerned, dr Jovanović emhpasises that Pap test is the standard one. In 2013. 12 primary health care centres participated in the organised screening of cervix. 37 will participate in 2014. and 14 of them will be from Belgrade. About 40 cervical cancers were discovered, but this number is considered biger. Dr Jovanović pointed out that from the whole number of cancers, 15% is colon cancer. In 2013. 19 primary health care centres participated in the organised colon screening, while 31 will participate in 2014. Till the end of 2013. 40 cancers and 127 adenoms were discovered. The problem with colon screening is continous testing and continous calling of patients.

Auditorium discussed and asked questions: physicians representatives of primary health care center Čukarica, Belgrade Institute for public health, as well as lawyers from SUPRAM, and from the Union Law Faculty, economists and others. Discussion was concentrated to the issues of the consent to screening, IT system, health insurance and screening of noninsured population, etc.