Organized CC screening in Latvia started in January 2009. It finally identified a comprehensive and optimal target group of residents for CC screening and enabled extensive opportunities for each healthcare provider willing to take part in the screening. Currently, the national Health Payment Center, which has been reorganized as the part of the National Health Service (Nacionalais veselibas dienests), is responsible for sending invitations to all women 25 to 69 years old, representing a total target population of 707,460 women. Screening is principally performed in a 3-year interval. GPs that have contracts with the National Health Service have access to the special screening module in the management information system, which is a central data repository of the National Health Service. The central screening database contains all relevant information on the women eligible for screening and registered with the particular healthcare provider: the date when the invitation was sent out, the reference number of the invitation, the screening date, and the test results. Regular monitoring of the central screening register allows GPs and their assistants or nurses to easily identify all women for whom screening invitations were issued but who have no test results. By identifying and actively contacting non-responding women, the GP can determine the reasons and encourage the women to respond to the screening invitation. If a woman visits the GP due to any medical condition and has no screening result recorded in the register, the GP can take cytological smears (if conditions in the practice allow), but must contact the National Health Service and request an invitation letter and screening examination form electronically. Gynecologists or obstetricians, who are now also involved in screening, act similarly, and they can use any visit (e.g., for birth control counseling) to encourage women to have cytological testing. All participating cytological laboratories must also enter the screening results in the screening module in the management information system.
In conclusion, an organized CC screening program was launched in Latvia in 2009, but not all components of organized screening are operational yet. The results of the first round of screening (20092011) show encouraging trends, with a stepwise increase in positive response to the personal invitation letter, an increase in coverage inside the program, and increasing detection of cervical high-grade lesions and carcinoma in situ. Nevertheless, there is still room for improvement: the most urgent is implementation of quality assurance at all levels of the program in compliance with European recommendations .
HPV testing with clinically validated tests should also be incorporated into patient management as soon as possible for at least two clinical applications:
(i) as a triage test to select women whose cytology is equivocal or mildly abnormal and who need referral for diagnosis and treatment, and (ii) as a follow-up test for women treated for high-grade CIN with local ablative or excisional therapy to predict cure or failure of treatment .
In the near future, there is a plan to modify data collection in the National Health Service database that will allow tracing the follow-up of women with abnormal smears, and linkage with other registers such as the Central Cancer Register.
We strongly believe that recent implementation of CC screening and vaccination against HPV will substantially reduce the incidence and mortality of CC in Latvia in the coming decade and create a solid background for CC to become a rare disease in this part of Europe.
