A MODERN VIEW ON THE CERVICAL CANCER SCREENING: UKRAINIAN AND GLOBAL EXPERIENCE

Abstract

One of the important medical problems consists in the prevalence and incidence of cervical cancer, implementation of innovative technologies in the diagnostics and treatment of this pathology.

Every six months, half a million women around the globe are taken ill by this disease, and 270 thousand women die of it. Undoubtedly, the major burden of this disease falls on developing countries. However, for economically developed countries with a well organized cervical screening, this problem remains topical too. In European countries, cervical screening allowed to significantly reduce the cervical cancer incidence in 80-90s of the previous century, for instance, in Great Britain, Sweden, and Finland. However, even in these countries, for the past 15-20 years, the number of women suffering from cervical cancer has not decreased. The main reason lies in epidemiological, social, and ecologic peculiarities of the modern world. If modern tendencies of cervical cancer incidence growth retain, then an annual number of people with cervical cancer may reach 1 million by 2050.

Based on the WHO assessment, there exist all prerequisites for cervical cancer elimination. Vaccination allows creating a sufficiently powerful collective immunity against HPV. There exist quite specific and sensitive methods for diagnostics and treatment of cervical precancer, which are being improved every year.  We are witnessing a change of diagnostic paradigm of cervical screening. The co-testing strategy came to replace the traditional PAP testing. Increased sensitivity and specificity of cytologic testing is achieved using the method of liquid-based cytology together with HPV testing. Initial HPV screening provides promising results, ensuring wide coverage of female population thanks to the possibility of independent sampling.

In Ukraine, cervical cancer incidence constituted 4,157 people in 2016-2017, while the death rate amounted to 1,757 women. The mortality rate up to one year constitutes 16.7%. It is worth noting that in 2017, the increase in cervical cancer incidence (21.5 against 20 per 100 thousand of the female population) and mortality (9 against 8.7 respectively) was recorded. Every day in Ukraine, 6 women die of this disease. And this happens despite the fact that we do have the infrastructure for opportunist cervical screening. Implementation of a new generation cervical screening will enable revolutionary HPV prevention, improved diagnostics, and treatment of cervical precancer.