Head of department for Cancer Screening, Head of ZORA programme
Urška Ivanuš, MD, PhD
T: +386 1 587 9606
ZORA is a national cervical cancer screening program aiming at reducing the cervical cancer incidence and mortality rate in Slovenia. It has its own web-site (in Slovene only).
Cervical cancer screening programmes have successfully reduced the incidence of and mortality from cervical cancer in several countries. Similar findings were identified in Slovenia after the implementation of the population-based, organised cervical cancer screening national programme (NP) ZORA. The NP ZORA was implemented in 2003 with conventional cytology in three-year screening intervals in women aged 20–64. The programme is managed by the Institute of Oncology Ljubljana, where the central screening registry is based. Since cervical cancer screening is implemented within the primary health care system, all Slovenian gynaecologists are involved in the programme, as well as nine cytopathology, eleven histopathology, and two laboratories for HPV testing. The programme was well accepted among the Slovenian women. The three-year coverage of the target population with a screening test is just above 70 percent, and its five-year coverage is just above 80 percent.
Slovenia is among the European countries with the highest historical cervical cancer incidence rates, but is also among the countries with the most pronounced decline in cervical cancer incidence rates over time. After the implementation of the ZORA NP, cervical cancer incidence almost halved. The lowest age-standardised incidence rate (world standard) was reported in 2014 (6.8/100,000), and the lowest mortality rate in 2016 (1.7/100,000). These results place Slovenia among the European countries with the lowest cervical cancer incidence and mortality. However, this has not always been the case. During the first years after the implementation of the Cancer Registry of Republic of Slovenia, namely from 1962 to 1965, cervical cancer was the second most common cancer in women. The highest registered incidence in Slovenia was reported in 1962 (27.5/100,000), which is comparable to the cervical cancer incidence in Africa today. A recent European study published in 2015 showed that Slovenia is not only among the European countries with the historically highest incidence of cervical cancer, but also among the countries that offer organised screening and have managed to reduce this incidence to the greatest extent possible. Mortality rate reports are available from year 1985, when the age-standardised cervical cancer mortality rate was 5.4/100,000.
Decrease in cervical cancer incidence in Slovenia is a result of efficient detection and treatment of pre-cancerous cervical lesions within the ZORA NP, and the reduction in mortality rate of cervical cancers patients is a result of cancer detection in early stages and more effective treatment.