Програма За Рана Детекција На Малигни Заболувања Во Република Северна Македонија За 2021 Година

Objectives

The 2021 programme establishes an integrated cancer-prevention and early-detection framework covering organised cervical and breast cancer screening, a colorectal cancer screening pilot, and prostate cancer prevention awareness.[1]It seeks to reduce cancer incidence, morbidity and mortality through increased screening uptake, earlier diagnosis, public awareness, professional education, reliable data and referral pathways.[2][3][4][5]

• Increase participation in organised cervical screening, improve women’s awareness of preventive examinations, and involve more gynaecologists in delivery.[2]
• Reach 75% of the cervical screening target population over a three-year period, the threshold identified for a successful organised programme.[2]
• Reduce colorectal cancer morbidity and mortality, improve public awareness of early detection, and educate health professionals.[3]
• Reduce colorectal cancer mortality by 20% to 30%, save 200 lives annually, reduce incidence by 20%, prevent 300 cases annually, and increase early detection from 14% to more than 50% within 10 years.[6]
• Screen people aged 50 to 70 for colorectal cancer using faecal occult blood tests, repeat testing every two years after a negative result, and refer positive cases for colonoscopy.[6][7]
• Promote prostate cancer prevention and early detection by encouraging preventive examinations for men aged 50 to 55 and men aged 40 to 50 with a family risk.[8]
• Reduce breast cancer mortality, improve quality of life, and reduce the need for radiotherapy and oncology treatment through early detection.[5]
• Detect breast cancer at a pre-clinical stage among apparently healthy women, in line with European screening recommendations.[9][5]
• Strengthen breast-screening capacity through improved data systems, service quality control, staff and equipment development, continuing education for technologists and radiologists, and expansion to mammography centres meeting quality and competency requirements.[5][10]

Implementation

Implementation combines Ministry of Health leadership, national coordination by the Institute of Public Health of the Republic of North Macedonia, local delivery by Public Health Centres and primary-care providers, specialised diagnostic services, electronic registries, public communication and structured reporting.[11][12][13]The Ministry leads strategic planning, coordination, monitoring, procurement of faecal occult blood tests and materials, and financing of planned screening activities.[12]

• Direct colorectal screening through an expert commission within the Ministry of Health, providing professional oversight and organisational and monitoring guidance to the Minister of Health.[12]
• Coordinate cervical screening nationally and locally through the Institute of Public Health, which prepares quarterly and annual reports, analyses results, develops recommendations for the Ministry, organises campaigns, distributes information materials and provides professional education.[11]
• Coordinate local cervical and colorectal activities through Public Health Centres, which liaise with practices and laboratories, collect reports, prepare quarterly reports, distribute materials, deliver awareness lectures and conduct local campaigns.[11][14]
• Require gynaecological practices to invite women, undertake examinations, collect and send Papanicolaou test samples to cytology laboratories, communicate results, and submit monthly or quarterly reports to Public Health Centres.[15]
• Assign cytology laboratories responsibility for preparing and examining Papanicolaou test material and submitting screening information through the reporting system.[15]
• Use the Directorate for Electronic Health to prepare colorectal screening invitation lists, distribute them to family doctors, develop the screening registry application and support indicator reporting.[12][13]
• Provide faecal occult blood test kits through family doctors, who inform and counsel patients, issue instructions and promotional materials, submit monthly reports, and advise patients to complete three consecutive tests.[14]
• Train family doctors through the Clinic for Gastroenterology and Hepatology in patient counselling, test-kit use, identification of high-risk patients and referral procedures.[16]
• Refer every person with a positive faecal occult blood test for colonoscopy in a public health institution.[17]
• Maintain the colorectal cancer register through the Institute of Public Health, which provides methodological support to Public Health Centres and submits quarterly reports and invoices to the Ministry of Health.[18]
• Promote prostate cancer prevention through a Ministry of Health awareness campaign and primary-care recommendations for preventive examinations.[8]
• Deliver breast screening through health institutions and eligible mammography centres, expanding provision only where equipment quality and staff competence meet the required criteria.[10]
• Monitor cervical screening through analysed Papanicolaou tests, detected cellular abnormalities, cervical cancer diagnoses, invitations, attendance, samples collected, participating providers and completed reports.[15]
• Track colorectal implementation through invitation coverage, test completion and adequacy, exclusions, refusals, results delivery, positive-result reporting, colonoscopy referral and follow-up.[17][4]
• Report colorectal activity monthly from family doctors to Public Health Centres, quarterly from Public Health Centres to the Institute, and quarterly and annually from the Institute to the Ministry of Health.[17]
• Monitor breast screening through examinations performed, invitation and attendance rates among women aged 50 to 69, imaging, referrals, positive findings, early-stage findings, image quality, equipment performance and radiation doses.[10]
• Finance breast-screening activities within the approved 2021 state budget of 25,500,000 denars, with Ministry of Health payments to eligible public and contracted private institutions and other implementers based on invoices and implementation reports.[19]

Monitoring & Evaluation

Monitoring and accountability span cervical, colorectal and breast cancer screening, with the Institute of Public Health of the Republic of North Macedonia playing a central coordination and evaluation role. Cervical screening relies on routine provider and laboratory reporting, while colorectal screening uses electronic databases, registries and a defined reporting chain. Breast screening tracks participation, findings and technical quality, although several reporting and accountability arrangements are not specified.[15][3][14][10]

• Monitor cervical screening outcomes through the number of PAP tests analysed, people with detected cellular abnormalities and people diagnosed with cervical cancer.[15]
• Track cervical screening processes through invitations issued, attendance following invitation, PAP samples collected, participating and informed gynaecologists, reporting practices and laboratories, and quarterly and annual reports produced.[15]
• Require gynaecological practices to submit monthly or quarterly reports to Centres for Public Health, alongside reporting by cytology laboratories.[15]
• Assess cervical programme reach against the benchmark of reaching 75% of the target population over three years.[2]
• Maintain continuous entry, submission and updating of organised-screening data by authorised programme implementers.[3][4]
• Use the Institute of Public Health organised-screening database and periodic reports compiled from cytology laboratory and public health centre reports to monitor and evaluate activities.[3][4]
• Evaluate screening activities and reporting against defined performance or success indicators, although the individual cervical indicators and targets are not fully specified beyond those listed for programme operations and colorectal objectives.[3][6][4]
• Operate colorectal monitoring through an opportunistic-screening database within the Directorate for Electronic Health and a colorectal cancer register maintained by the Institute of Public Health.[18][14]
• Report colorectal screening data through family doctors, public health centres and the Institute of Public Health: family doctors report by the seventh day after each month, public health centres within 15 days after each quarter, and the Institute within 30 days after each quarter and year.[17]
• Prepare quarterly reports for the Ministry of Health and publish an annual colorectal screening report, including the programme status and results achieved in 2021.[14][17]
• Track colorectal invitations, receipt of invitations, completed FOB tests, exclusions, refusals, results issued and inadequate tests.[17]
• Assess colorectal implementation through the number and proportion of people covered, completing FOB tests and completing adequate FOB tests.[17]
• Assess colorectal short-term performance through uptake, the speed of reporting positive findings, colonoscopy referral and follow-up of people with positive tests; assess long-term performance through reductions in mortality, morbidity and incidence.[4]
• Track colorectal cancer population rates, reports of preventive examinations, trained health workers and facilities equipped for systematic examinations.[4]
• Monitor breast screening through examinations performed; women invited relative to the population aged 50–69; attendance and imaging; referrals for further examination; positive findings; and early-stage positive findings.[10]
• Assess breast-screening technical and diagnostic image quality, mammography equipment performance and radiation doses through dedicated reports.[10]
• Clarify that the supplied material does not specify breast-screening reporting frequency, detailed surveillance procedures, evaluation arrangements or accountability sanctions.[10]

Costing & Financing

Financing is led by the Ministry of Health, which procures colorectal Faecal Occult Blood Test kits and materials, finances planned colorectal screening activities and provides resources to implementing public health centres.[6][18][12]The only explicit monetary allocation in the supplied material is 25,500,000 denars from the 2021 state budget for the early detection programme.[19]

• Procure and distribute Faecal Occult Blood Test kits for the colorectal pilot according to the covered population, with the Ministry of Health responsible for procurement.[6]
• Finance colorectal screening activities and provide financial resources to implementing public health centres.[18][12]
• Submit quarterly invoices to the Ministry of Health for colorectal screening undertaken in North Macedonia.[18]
• Allocate colorectal screening finance to public health institutions and activity implementers after completion of activities, based on submitted invoices and reports.[7]
• Distribute the approved 2021 early detection programme budget to public health institutions, private health institutions contracted with the Health Insurance Fund of North Macedonia, and other implementers, based on invoices and implementation reports.[19]
• Seek to reduce colorectal cancer treatment costs as a programme objective, without quantifying anticipated savings.[6]
• Note that the supplied extracts do not specify colorectal or cervical monetary budgets, unit costs, detailed allocations, funding gaps or economic assumptions.[1][2][15][6][12]
• Note that individual allocations, funding gaps and wider economic assumptions for the breast-screening allocation are not specified.[19]