Nationwide Study on the Cervical Cancer Screening Pathway in Estonia.

Area of Science:

• Public Health
• Gynecologic Oncology
• Epidemiology

Background:

• Cervical cancer elimination relies on effective screening and follow-up.
• Data on human papillomavirus (HPV)-based screening follow-up in Eastern Europe are limited.
• Organized screening programs face challenges in ensuring complete patient care pathways.

Purpose of the Study:

• To assess follow-up adherence after positive high-risk HPV (hrHPV) tests in Estonia.
• To identify barriers to complete follow-up in a national cervical cancer screening program.
• To evaluate progress toward World Health Organization (WHO) cervical cancer elimination targets.

Main Methods:

• Nationwide, population-based retrospective cohort study in Estonia.
• Analysis of 44,282 women aged 30-65 screened for hrHPV between 2021-2022.
• Utilized data from the Estonian Health Insurance Fund and Population Register.

Main Results:

• Screening attendance was 45.7%; 8.0% tested hrHPV-positive.
• A significant 57.7% loss to follow-up was observed among hrHPV-positive women within 12 months.
• Colposcopy was performed in 77.9% of referred women; HSIL treatment was high (85.5%).

Conclusions:

• Suboptimal screening uptake and high loss to follow-up hinder cervical cancer prevention in Estonia.
• Older age and southern residence predicted lower follow-up adherence.
• Enhancing follow-up is crucial for timely diagnosis, treatment, and global cervical cancer elimination efforts.