Analiza rezultata oportunog i organizovanog skrininga za rak grlića materice u beogradskoj opštini Čukarica

Abstract

Skrining (engl. ―screening‖) u medicinskom smislu podrazumeva preventivne preglede naizgled zdravog stanovništva kako bi se uz pomoć jednostavno primenljivih medicinskih testova, još u asimtomatskoj fazi otkrile osobe sa predispozicijom za nastanak nekog oboljenja. Oportuni skrining (OPS) za rak grlića materice (RGM) predstavlja nesistematsku primenu Papanicolaou (PAP) testa na osnovu individualne odluke ţene ili njenog lekara dok organizovani skrining (ORS) podrazumeva organizovano, masovno pozivanje ciljne populacije na testiranje koje je unapred planirano, sa jasno definisanom metodologijom, vrstom testa i kontrolom kvaliteta rada. Cilj istraţivanja je bio analiziranje rezultata prvog trogodišnjeg ciklusa ORS za RGM (20.12.2012.-19.12.2015.) i njihovo uporeĎivanje sa rezultatima koje smo imali u poslednjem trogodišnjem ciklusu OPS (20.12.2009.-19.12.2012.) kako bi se doneli korisni zaključci za dalji rad na prevenciji RGM u opštini Čukarica. Ciljnu populaciju (CP) ovog istraţivanja činile su ţene u dobu od 25-64 godine ţivota koje su u navedenom vremenskom periodu PAP-test uradile u Domu zdravlja ―Dr Simo Milošević‖. Rezultati: Ukupni (ORS+OPS) trogodišnji obuhvat CP (25-64) PAP-testom bio je statistički značajno veći u periodu nakon implementacije ORS (20.12.2012.-19.12.2015.) u odnosu na trogodinji period (20.12.2009.-19.12.2012.) kada smo sprovodili isključivo OPS (37,41% vs. 21,4%, χ2=3532.8 p<0.01). U toku ORS (20.12.2012.-19.12.2015.) uraĎeno je 17172 PAP-testova kod 16305 ţena od čega je PAP-test bio pozitivan kod 622 (3,82%) ţene. U paralelnom OPS je uraĎeno 7865 PAP-testova kod 5284 ţena CP (25-64) koje nisu prethodno učestvovale u ORS od čega je PAP-test bio pozitivan kod 144 (2,7%) ţene. Tokom prethodnog OPS (20.12.2009.-19.12.2012.), uraĎeno je 20235 PAP-testova kod 12117 ţena od čega je PAP-test bio pozitivan kod 311 (2.6%) ţena. Statistički značajno veći broj pozitivnih PAP-testova je otkriven u okviru ORS u odnosu na OPS i to kako pre, tako i u trogodišnjem periodu nakon implementacije ORS (p<0,01). Potrošnja brisa je bila statistički značajno manja (p<0,01) unutar ORS (1,1 po ţeni) u odnosu na prethodni OPS (1,7 po ţeni) kao i u odnsu na parlelni OPS (1,5 po ţeni)...

The term "Screening" in the medical sense refers to the preventive examinations of seemingly healthy population with the help of easily applicable medical tests in order to detect asimptomatic people with a predisposition for the development of certain diseases. Opportunistic screening (OPS) is the unsystematic taking of the Papanicolaou (PAP) smears which is administered by to the individual initiative of women themselves or their doctors, while organized screening (ORS) implies an organized, mass calling of the target population for testing that is pre-planned, with a clearly defined methodology, type of test and quality assurance. The aim of this study was to analyze the results of the first three-year interval of the ORS (20.12.2012.-19.12.2015.) and their comparison with the results we've had in the last three-year of the OPS (20.12.2009.-19.12.2012.), in order to bring useful conclusions for further work on the prevention of CC in the municipality of Čukarica. The target population (TP) of this study were women aged 25 to 64 who had PAP tests done during the said period at the Primary Health Center "Dr Simo Milosevic". Results: The total three-year PAP test coverage (ORS+OPS) for women aged 25 to 64 was significantly higher after the implementation of the ORS (20.Dec.2012.-19.Dec.2015.) compared to the three-year period (20.Dec.2009.-19.Dec.2012.) when we exclusively conducted opportunistic screenings (37.41% vs. 21.4%, χ2 = 3532.8 p <0.01). During the period of the ORS 17172 PAP tests were done in 16305 women, of whom PAP test was positive in 622 (3.82%). In parallel, within OPS 7865 PAP tests were done in 5284 women (25-64) which have not previously participated in the ORS. PAP test was positive in 144 (2.7%) women. During the previous OPS (20.12.2009.-19.12.2012.) 20235 PAP tests were done in 12117 women, of which the PAP test was positive in 311 (2.6%). Significantly higher numbers of positive PAP tests were revealed within the ORS compared to the OPS, both before and during the three years after the implementation of the ORS (p <0.01). PAP-test consumption was significantly lower (p <0.01) in the ORS (1.1 per woman) compared to the previous OPS (1.7 per woman) as well as in the parallel OPS (1.5 per woman). Within the ORS, pathohistological (PH) verification of the cervical lesions was performed in 305 women of which PH result was negative for CIN/ICC in 182 (59.7%), CIN1 was detected in 27 (8.9%), CIN2 in 25 (8.2%), CIN 3 in 47 (15.4%), while invasive cancer (ICC) were detected in 24 (7.9%) women. Interval cancer was confirmed in two cases...