Expanding eligibility and improving quality of cervical cancer screening in Estonia
The 2021 reforms
Bibliographic Data
| ID | 21467620 |
|---|---|
| Authors | Samuel Rigby (0000-0002-8784-6257, London School of Hygiene & Tropical Medicine, corresponding author), Rachel Neff Greenley (0000-0001-5691-6964, London School of Hygiene & Tropical Medicine), Rachel Greenley, Anneli Uusküla (0000-0002-4036-3856, University of Tartu), Anna Tisler (0000-0002-2055-9421, University of Tartu), Maria Suurna (Estonian E Health Foundation), Maris Jesse, Marc Bardou (0000-0003-0028-1837, Inserm), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine) |
| Year | 2024 |
| Volume | 144 |
| Pages | 105077 |
| Publication date | 2024-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy (JOURNAL) |
| Journal identifiers | ISSN: 0168-8510 • E-ISSN: 1872-6054 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.healthpol.2024.105077 |
| PMID | 38678760 |
| OpenAlex | W4395111397 |
| Language | EN |
| Citations received | 2 |
| References cited | 15 |
A single payer and established population register facilitated reform. • Complex governance structures created delays to reaching consensus on policy responses. • Change was facilitated by concerns about quality and coverage. • Cancer screening needs explicit monitoring with effective oversight and clear accountability. Estonia has one of the highest death rates from cervical cancer in the European Union despite having had a population-based screening programme for over 15 years. In 2021, this high disease burden, alongside a new national cancer prevention plan, prompted a series of cervical cancer screening programme reforms to address low screening uptake and evidence of variable screening test quality. The reforms had three main elements: expansion of eligibility to all women aged 30–65 regardless of insurance status; increasing test provision by enabling family physicians to take screening samples and introducing self-sampling; and improving testing procedures, replacing cytology with HPV testing as the primary screening test. Although the impact of these changes is yet to be seen, early signs suggest increased programme participation. However, at 51 %, further action to address barriers to uptake will likely be necessary. If Estonia is to avoid another period of policy dormancy, as happened between 2006 and 2021, greater clarity on screening programme accountability is required. The establishment of the National Cancer Screening Group may enable this. The first test will be the delivery of an end - to-end evaluation of the reformed programme, with an emphasis on equity of access. The next step will be to develop and deliver solutions that respond to these needs
Accountability · Cancer · Cancer screening · Cervical cancer · Cervical cancer screening · Cervical screening · CLARITY · Environmental health · Family medicine · Pap test · Political science · Population · Cervical Cancer and HPV Research · Global Cancer Incidence and Screening · Medicine
| Citations per year | 2 |
|---|---|
| Citation span | 2025 - 2026 (2) |
| Highly cited | No |