MONTENEGRO Negotiating Team for the Accession of Montenegro

MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 28 – Consumer and Health Protection Bilateral screening: Chapter 28 PRESENTATION OF MONTENEGRO Brussels, 15 -16 April 2013

. Chapter 28: Consumer and Health Protection CANCER Dr Mensud Grbovic Deputy Minister Ministry of Health mensud. grbovic@mzd. gov. me MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Contents q q q q Relevant Acquis Institutional framework National Legislation Montenegro National Cancer Control Plan National program for early colorectal cancer detection National program for early cervical cancer detection National program for early breast cancer detection MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Relevant Acquis • Council Conclusions on action against cancer (13 September 2010) • Council Conclusions on reducing the burden of cancer (10 June 2008) 32003 H 0878 (EUR-Lex: 15. 30) • Council Recommendation of 2 December 2003 on cancer screening (OJ L 327, 16. 12. 2003, p. 34) MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection National Legislation • • • The Constitution of Montenegro Law on Health care (Official Gazette no. 39/2004, no. 14/2010) Law on health insurance (Official Gazette no. 39/2004, no. 14/2012) Law on the health care data collections (Official Gazette no. 80/2008) Strategy for prevention and control of noncommunicable diseases Regulation on detailed content, form and manner of keeping register of diseases of major socio-medical importance, infectious diseases and other conditions related to population health (Official Gazette no. 24/2012) Montenegro national cancer control plan National program for early cervical cancer detection National program for early colorectal cancer detection National program for early breast cancer detection MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Institutional Framework • Ministry of Health (National Cancer Control Committee) • Institute of Public Health • Health care institutions • Health Insurance Fund MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Leading causes of death by diagnostic groups in Montenegro in 2009 Circulatory diseases, 54. 9% Other causes of death, 7. 2% Injuries, 4. 0% Pulmonary diseases, 4. 7% Insufficiently defined conditions, 14. 0% Tumors, 15. 2% MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Most frequent cancers as cause of death among men in Montenegro in 2009 Other, 26. 4% Lungs, 41. 3% CNS, 4. 8% Pancreas, 5. 2% Prostata, 9. 3% Larynx, 6. 3% Colon and rectum, 6. 7% MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Most frequent cancers as cause of death among women in Montenegro in 2009 Lungs, 16. 8% Other, 33. 1% Breast, 18. 9% Ovary, 5. 2% Stomach, 4. 4% Pancreas, 6. 4% Cervix uteri, 3. 1% MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Colon and rectum, 12. 1% Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Montenegro – Estimated age standardized incidence for 2008* Indictors Male Female Both sexes Estimated ASR Incidence per 100000 231, 1 185, 2 204, 3 Risk of getting cancer before age 75 (%) 24, 0 18, 9 21, 2 17, 6 10, 9 13, 9 Risk of dying from cancer before age 75 (%) *Globocan 2008 (IARC). Section of cancer information MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Montenegro National Cancer Control Plan Key Aims • Improving the efficiency and cancer control through data collection and surveillance • Reduction in cancer incidence through primary prevention measures • Ensuring early detection and screening program aimed at reducing the cancer-related incidence and mortality • Improvement of organization and services for diagnostics and treatment of malignant diseases, aimed at reducing the morbidity and mortality • Improving the quality of life of cancer patients and their family through the establishment of palliative care and rehabilitation services • Quality improvement • Strengthening human resources and education MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection National program for early cervical cancer detection • Raising awareness about the cervical cancer problem and the importance of regular checkups • Reduction of mortality caused by cervical cancer by 50% in the period of 10 years after the beginning of implementation of the Program; • Reduction of cervical cancer incidence by 50 -60% in the period of 8 years after the beginning of implementation of the Program ; • Coverage of at least 50% of target population in the period of 3 years after the beginning of implementation of the Program; MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Target Population • Women aged 24 -64 years, with the interval of examination in every three years MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Organization of the program for early breast cancer detection • Continuous media campaign about the importance of prevention and early detection of cervical cancer • Additional training and education of pathologists, and motivation of staff in primary health care (chosen doctors and nurses) • Invitations for PAP test sent from the primary health care centers to the home addresses of eligible women together with educational brochure and questionnaire • Cytological examination of cervical smears would be performed at the designated centers • Further diagnostic processing and treatment, if needed, at secondary and tertiary health care institution MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection National program for early colorectal cancer detection • Reduction of mortality caused by colorectal cancer by 15% in the period of 5 years after the beginning of implementation of the Program; • Detection of colorectal cancer at the early stage of disease and thus enhancing possibility of healing, quality of life and survival; • Coverage of at least 60% of target population MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Target Population • Men and women aged 50 -74 years, with the interval of examination in every two years using test for occult bleeding MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Organization of the program for early colorectal cancer detection • Continuous media campaign about the importance of prevention and early detection of colorectal cancer • Additional training and motivation of staff in primary health care (chosen doctors and nurses) • Invitations for occult bleeding testing to be sent from the primary health care centers to the home addresses of eligible population together with educational brochure and questionnaire • Further diagnostic processing, if needed, in designated endoscopic center MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection National program for early breast cancer detection • Raising awareness about the breast cancer problem • Reduction of female mortality caused by breast cancer by 15% in the period of 5 years after the beginning of implementation of the Program; • Early detection of breast cancer above 80% with the possibility to detect in situ lesions above 10% ; • Improvement of the quality of life of female patients suffering from breast cancer. MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Target Population • Healthy women aged 40 -69 years, with the interval of examination in every two years MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Organization of the program for early breast cancer detection • Continuous media campaign about the importance of prevention and early detection of breast cancer • Additional training and motivation of staff in primary health care (chosen doctors and nurses), as well as radiologists and surgeons • Invitations for mammography examination to be sent from the primary health care centers to the home addresses of eligible women together with educational brochure and questionnaire • Mammography examination would be performed at the Centers for Radiological Diagnosis at the primary health care centers (double independent reading of mammography) • Further diagnostic processing and treatment, if needed, in designated centers MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Activities • Establishment of the National Cancer Register is in process • Organization of screening for colorectal cancer is in process and its beginning is planned on the 22. 04. 2013 • National guideline on therapy of chronic cancer pain MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Chapter 28: Consumer and Health Protection Challenges • • Stable sources of financing Sustainable organization Awareness of population Motivation of health workers (especially chosen doctors) Human resources Physical resources Establishment of palliative care MONTENEGRO Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION

Thank you for your attention. QUESTIONS