Since the middle of the last century, opportunistic screening was implemented in the Republic of Croatia, and this led to a reduction in the incidence and mortality of cervical cancer. However, with the opportunistic programme it is not possible to reduce the incidence of disease under 10/100.000, since most of the new cases arise from the part of the population that is not covered with screening. Ministry of Health of the Croatian Government started in December 2012 implementation of national organised cervical cancer screening programme. The objectives of the programme are to decrease the incidence of invasive cervical cancer by 60% in the age group 25-65 years after 8 years from the beginning of the programme, reducing mortality by 80% in the age group 25 to 70 years after 13 years and gradual cessation of opportunistic screening.
The organisation of the national programme includes the creation of a database of the target population, organization of the activate invitations (call/recall system) and establishment of follow-up protocol and monitoring. The target population is all asymptomatic women aged 25 to 65. Screening interval is 3 years, which means the invitation of about 400,000 women annually. Screening test is conventional Pap test, which is conducted according to the guidelines given by gynaecological and cytological professional associations. The predictive value of the screening method can be raised by introducing HPV molecular detection test. HPV tests, which detect HPV infections associated with cervical cancer, can forecast cervical cancer risk many years in the future and are currently recommended to be used in conjunction with the Pap test in some women, either as an additional screening test or when Pap test results are uncertain.
Most cervical precancers develop slowly, so cancer can usually be prevented if a woman is screened regularly. We expect to improve the quality of the programme by introducing HPV testing. invasive disease ranging from 50% (meta-analysis) to 70% at best. The predictive value of the screening method can be raised by introducing HPV molecular detection test. HPV tests, which detect HPV infections associated with cervical cancer, can forecast cervical cancer risk many years in the future and are currently recommended to be used in conjunction with the Pap test in some women, either as an additional screening test or when Pap test results are uncertain. HPV tests can also identify women at risk for an uncommon type of cervical cancer (adenocarcinoma) that is often missed by Pap tests.