Proposals for opportunistic cervical cancer screening in the Republic of Croatia

Cervical cancer is the fourth most common malignant disease worldwide in women and the fourth cause of death. The incidence is much higher in developing countries without screening and where this disease is the leading cause of death among all gynecological malignancies. Cervical cancer screening prevents the development of invasive cancer by detecting premalignant lesions and the microinvasive stage of cervical cancer. New guidelines for the prevention of cervical cancer should take into account the progress in molecular diagnostics and the use of HPV tests, and majority of countries are switching to screening primary with the HPV test. As the combination of cytology and HPV test (co-testing) is superior in terms of sensitivity and specificity compared to the independent use of these tests, some countries decide to screen with co-testing. The aim of this paper is to show and explain the best screening model in the Republic of Croatia, to define when to start screening, which tests to use and at what time intervals. Each country must adapt the screening model to its health system and capabilities. Taking into account the current situation in cervical cancer screening, the quality and availability of cytology laboratories, as well as the possibility of molecular diagnostics, the authors of this paper concluded that the dual testing (co-testing) model is the most suitable for opportunistic screening carried out in the Republic of Croatia. Screening should start at the age of 21, and until the age of 29 the primary test should be the Pap smear at 3-year intervals. After the age of 30, also at intervals of three years, the primary test should be co-testing. In cases of negative tests, screening ends at the age of 65. A dual staining test for p16/Ki-67 can be used as a triage test. Finally, the most important factor for a successful screening is the percentage of the population which is included in the screening program, what should be the primary goal.