Browsing by Author "Pärna, Kersti"
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Item Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden : results of a cross-sectional study in Estonia(2023-06-01) Pärna, Kersti; Nygård, Mari; Tisler, Anna; Toompere, Karolin; Naaber, Paul; Ratnik, Kaspar; Ķīvīte Urtāne, Anda; Zodzika, Jana; Stankūnas, Mindaugas; Baltzer, Nicholas; Uusküla, Anneli; Institute of Public Health; Department of Public Health and Epidemiology; Department of Obstetrics and GynaecologyOBJECTIVES: To describe age-specific and type-specific carcinogenic human papillomavirus (HPV) prevalence prior to large-scale effect of HPV vaccines in Estonia and to analyse the risk factors associated with carcinogenic HPV. DESIGN: Cross-sectional study using self-administered questionnaire and self-collected vaginal swabs for detection of HPV infection. SETTING: Estonian Biobank database. PARTICIPANTS: Stratified random sample of women aged 30-33, 57-60 and 67-70 years living in one of the three largest counties in Estonia. Of 3065 women approached, 1347 (43.9%) returned questionnaires and specimens for HPV DNA detection. OUTCOME MEASURES: HPV prevalence and fully adjusted ORs with 95% CIs for risk factors. RESULTS: HPV prevalence was highest among women aged 30-33 years (18.7%; 95% CI 15.8 to 21.9) followed by those aged 67-70 years (16.7%; 95% CI 12.4 to 22.0) and 57-60 years (10.2%; 95% CI 7.8 to 13.3). HPV16 and HPV56 were the most common among women aged 30-33 years (both 4.0%; 95% CI 2.7 to 5.9), and HPV68 was the most common among women aged 57-60 years (2.8%; 95% CI 1.5 to 4.7) and 67-70 years (6.4%; 95% CI 3.6 to 10.4). Vaccination with nonavalent vaccine would have halved the carcinogenic HPV prevalence among women aged 30-33 years. The odds of infection with carcinogenic HPV were higher among women with six or more sexual partners among younger (OR 2.99; 95% CI 1.54 to 5.81) and older (OR 3.80; 95% CI 1.25 to 11.55) women and lower (OR 0.35; 95% CI 0.17 to 0.72) among younger married women. CONCLUSIONS: This study demonstrated U-shaped age-specific genotype profile of carcinogenic HPV prevalence, indicating that public health providers should focus on developing exit strategies for the cervical cancer screening programme in Estonia with a possible extension of HPV testing beyond the current screening age of 65 years. Generalisability of the findings of this study may be affected by the low response rate.Item Cervical Cancer in the Baltic States : Can Intelligent and Personalized Cancer Screening Change the Situation?(2022) Stankūnas, Mindaugas; Pärna, Kersti; Tisler, Anna; Ķīvīte-Urtāne, Anda; Kojalo, Una; Zodzika, Jana; Baltzer, Nicholas; Nygard, Jan; Nygard, Mari; Uuskula, Anneli; Institute of Public HealthThe three Baltic States (Estonia, Latvia, and Lithuania) are among the European Union countries with the highest incidence and mortality rates for cervical cancer. In order to tackle this public health challenge, there is an urgent need to implement more advanced and effective methods in cervical cancer prevention in Baltic countries. Nationwide cervical cancer screening programs in the Baltic States commenced in 2004-2009. While the organized screening programs in these countries differ in some relevant details (target age groups, screening interval), the underlying principles and problems, barriers are universal. However, the outcomes of present screening programs are unsatisfactory. In addition, universal screening programs are extremely costly. There is a potential need for more intelligent and personalized cervical cancer screening program. In 2019 the project "Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening" (2020-2023) was developed with the main objective - to develop improved and personalized cancer screening methods within a sustainable health care system. It is expected, that more sophisticated cervical cancer screening model will be implemented in Estonia, Latvia, and Lithuania, and will have a positive impact to epidemiology of cervical cancer and public health in general.Item Cervical cancer screening attendance related factors among women in Latvia(2023-10-01) Spriņģe, Lauma; Ķīvīte-Urtāne, Anda; Kursīte, Mirdza; Čurkste, Alise; Zodzika, Jana; Pärna, Kersti; Uuskula, Anneli; Institute of Public Health; Department of Obstetrics and GynaecologyCervical cancer is the second leading cause of death in Latvia among women aged 15-44. Since 2009 organized cancer screening has been available, but responsiveness from the target population was still not optimal - only half of the invited persons participated in screening in 2022. Our study aimed to analyse sociodemographic factors and knowledge about screening concerning participation in the screening procedure. Data from a cross-sectional population survey conducted in 2021-2022 were analysed (n = 1313). The survey was part of the project “Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening” (EMP416). A multivariate model was adjusted for independent variables found to be statistically significantly associated with the outcome in univariate analysis. The dependent variable was participation in cervical cancer screening. Independent variables - knowledge about screening, age, education, marital status, and employment 81 % (n = 1063) of respondents participated in cervical cancer screening. The odds of screening attendance were higher among women aged 30-39 (aOR=3.6, p < 0.001), 40-49 (aOR=2.8, p = 0.005), 50-59 (aOR=12.3, p = 0.001) in comparison to women aged 25-29 years. Secondary (aOR=5.9, p < 0.001) and university (OR = 13.1, p < 0.001) education in comparison to primary education and being married (OR = 3.7, p < 0.001) to being single, as well as being employed (OR = 2.0, p = 0.085) and economically inactive (OR = 3.1, p < 0.05) in comparison to unemployment was associated with cervical cancer screening attendance. Knowledge about screening was associated with higher odds of participation (OR = 4.1, p = 0.001). Knowledge about screening is positively related to attendance. Differences were observed across various sociodemographic groups emphasizing the importance of providing targeted information for vulnerable social groups such as the elderly, single and unemployed women, and women with lower education to promote cervical cancer screening.Item Comment on "The European response to the WHO call to eliminate cervical cancer as a public health problem"(2023-08-15) Tisler, Anna; Nygard, Mari; Kivite-Urtane, Anda; Berza, Natalija; Zodzika, Jana; Stankunas, Mindaugas; Baltzer, Nicholas; Pärna, Kersti; Uusküla, Anneli; Institute of Public Health