Abstract
Background: Cervical cancer is the second most common cancer in women worldwide, where the majority of registered patients are in developing countries. Screening programs in developed countries have reduced morbidity and mortality from cervical cancer by more than 2 times. Cervical cancer (CC) is the most common gynecologic cancer in Kazakhstan. In 2016, the standardized incidence rate of CC was 19.1 per 100,000, while the mortality rate was 7.1 per 100,000. The National Cervical Screening program in Kazakhstan has been using cytology (The Papanicolaou test) since 2008, free for women aged 30 to 60 years and performed at 5-year intervals. Despite the introduction of cytologic screening, the mortality rate remains high. Aim: The purpose of this study is to analyze the effectiveness of cytologic screening in Kazakhstan. Methods: Coverage analysis, the number of screened women, the level of precancer detection and cervical cancer during screening have been obtained from specific reports (form no. 025, no. 08) for 2008-2016. Results: The number of screened women totaled at 4,460,320. There has been a decrease of 32% in the number of screened women within the nine-year period. Furthermore, the coverage rate has decreased within the said period by 27%, from 72.9% in 2008% to 45.9% in 2016, with the highest coverage in 2012. According to the results of the screening, 1576 cases of CC were registered. The analysis of the screening results showed a marked increase in the detection of CC with an increase of 37%. At the same time, the percentage of detection of the initial stage during screening remains insufficient and for 2016 was 50.8%. The percentage of registered cases of ASH+HSIL increased from 0.136% to 0.673%. Conclusion: An analysis of the cytologic screening for 2008-2016 showed a high incidence of CC. Despite sufficient coverage and relative success in detecting the initial stages of CC, the mortality rate remains high. Thus, it is necessary to improve the effectiveness of CC screening in Kazakhstan through the introduction of HPV-screening.
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