Browsing by Author "Stankunas, Mindaugas"

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    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
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    Nationwide study on development and validation of a risk prediction model for CIN3+ and cervical cancer in Estonia
    (2024-10-19) Tisler, Anna; Võrk, Andres; Tammemägi, Martin; Ojavee, Sven Erik; Raag, Mait; Šavrova, Aleksandra; Nygård, Mari; Nygård, Jan F; Stankunas, Mindaugas; Kivite-Urtane, Anda; Uusküla, Anneli; Institute of Public Health
    Transitioning to an individualized risk-based approach can significantly enhance cervical cancer screening programs. We aimed to derive and internally validate a prediction model for assessing the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cancer in women eligible for screening. This retrospective study utilized data from the Estonian electronic health records, including 517,884 women from the health insurance database and linked health registries. We employed Cox proportional hazard regression, incorporating reproductive and medical history variables (14 covariates), and utilized the least absolute shrinkage and selection operator (LASSO) for variable selection. A 10-fold cross-validation for internal validation of the model was used. The main outcomes were the performance of discrimination and calibration. Over the 8-year follow-up, we identified 1326 women with cervical cancer and 5929 with CIN3+, with absolute risks of 0.3% and 1.1%, respectively. The prediction model for CIN3 + and cervical cancer had good discriminative power and was well calibrated Harrell's C of 0.74 (0.73-0.74) (calibration slope 1.00 (0.97-1.02) and 0.67 (0.66-0.69) (calibration slope 0.92 (0.84-1.00) respectively. A developed model based on nationwide electronic health data showed potential utility for risk stratification to supplement screening efforts. This work was supported through grants number PRG2218 from the Estonian Research Council, and EMP416 from the EEA (European Economic Area) and Norway Grants.
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    An overview of cervical cancer epidemiology and prevention in the Baltic States
    (2023-01) Kojalo, Una; Tisler, Anna; Parna, Kersti; Kivite-Urtane, Anda; Zodzika, Jana; Stankunas, Mindaugas; Baltzer, Nicholas; Nygard, Mari; Uuskula, Anneli; Institute of Public Health
    AIMS: To inform future Baltic States-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Estonia, Latvia and Lithuania. METHODS: A structured desk review: we compiled and summarized data on current prevention strategies, population demography and epidemiology (high risk human papillomavirus (HPV) prevalence and cervical cancer incidence and mortality over time) for each Baltic State by reviewing published literature and official guidelines, performing registry-based analyses using secondary data and having discussions with experts in each country. RESULTS: We observed important similarities in the three Baltic States: high burden of the disease (high incidence and mortality of cervical cancer, changes in TNM (Classification of Malignant Tumors) stage distribution towards later stage at diagnosis), high burden of high-risk HPV in general population and suboptimal implementation of the preventive strategies as low screening and HPV vaccination coverage. CONCLUSIONS: Cervical cancer remains a substantial health problem in the region and the efforts in addressing barriers by implementing a four-step plan for elimination cervical cancer in Europe should be made. This goal is achievable through evidence-based steps in four key areas: vaccination, screening, treatment, and public awareness.