{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:23:55Z","timestamp":1785187435635,"version":"3.55.0"},"reference-count":56,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002301","name":"Eesti Teadusagentuur","doi-asserted-by":"publisher","award":["PRG2218"],"award-info":[{"award-number":["PRG2218"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002301","name":"Eesti Teadusagentuur","doi-asserted-by":"publisher","award":["PRG2543"],"award-info":[{"award-number":["PRG2543"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,8,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Effective cervical cancer screening and progress toward WHO elimination targets depend on complete follow\u2010up for women with positive primary screening tests. However, real\u2010world data on this critical step in hrHPV\u2010based screening programs in Eastern Europe are scarce. We conducted a nationwide, population\u2010based retrospective cohort study in Estonia, analyzing records from the Estonian Health Insurance Fund and Population Register. We included 44,282 women aged 30\u201365 who were invited to hrHPV\u2010based screening between January 1, 2021, and December 31, 2022, with follow\u2010up through March 31, 2024. Screening attendance was 45.7% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200920,242; 95% CI: 45.2%\u201346.2%), with 8.0% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091615; 95% CI: 7.6%\u20138.4%) testing hrHPV\u2010positive. A substantial loss to follow\u2010up was observed: 57.7% of hrHPV\u2010positive women did not undergo repeat hrHPV testing, colposcopy, or any post\u2010colposcopy care within 12\u2009months. Among those referred for further diagnosis, colposcopy was performed in 77.9% within 6\u2009months. Treatment for High\u2010Grade Squamous Intraepithelial Lesion (HSIL) cases was high (85.5%;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009124; 95% CI: 78.7%\u201390.5%), mostly within 3\u2009months. Predictors of lower follow\u2010up adherence included older age and residence in South Estonia. Suboptimal screening uptake and high loss to follow\u2010up among hrHPV\u2010positive women are significant barriers to effective cervical cancer prevention in Estonia. These challenges mirror those seen in many organized screening programs globally. Prioritizing strategies to enhance follow\u2010up adherence is critical for timely diagnosis and treatment, ultimately accelerating global efforts toward cervical cancer elimination.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70466","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:56:59Z","timestamp":1775797019000},"page":"883-895","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nationwide Study on the Cervical Cancer Screening Pathway in Estonia"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6910-5033","authenticated-orcid":false,"given":"Aleksandra","family":"\u0160avrova","sequence":"first","affiliation":[{"name":"North Estonia Medical Centre Women's Clinic  Tallinn Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Jakoby","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health University of Tartu  Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-9421","authenticated-orcid":false,"given":"Anna","family":"Tisler","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health University of Tartu  Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0120-2213","authenticated-orcid":false,"given":"Kaire","family":"Innos","sequence":"additional","affiliation":[{"name":"National Institute for Health Development  Tallinn Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dclo","family":"Maiv\u00e4li","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health University of Tartu  Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Jaal","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine University of Tartu  Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneli","family":"Uusk\u00fcla","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health University of Tartu  Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_13_3_1","unstructured":"\u201cThe Cancer We Can Eliminate \u2013 WHO\/Europe Urges Member States to Consign Cervical Cancer to History \u201d accessed March 9 2025 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