Historical milestones of the Slovenian National Cervical Cancer Screening Programme ZORA

1960

• First implementation of preventive gynaecological exams in Slovenia (opportunistic screening/non-organized programme, unstandardized test results).

1991

• First edition of the European guidelines for quality assurance in cervical cancer screening.

1996

• The Committee on Health of Republic Slovenia approves the proposal of the establishment of National Cervical Cancer Screening Programme ZORA.
• Assoc. Prof. Dr. Maja Primic Žakelj is named the head of the project for the establishment of the National Cervical Cancer Screening Programme ZORA.

1998

• ZORA registry establishes a connection with the Central Population Register, Register of Spatial Units and laboratories. Floppy disks are used for data transfer.
• Start of a pilot project in Ljubljana region and later (2001) in coastal region - the beginning of organized cancer screening in Slovenia.

2000

• National guidelines for screening, treatment and post-treatment management of precancerous lesions for cervical cancer are published for the first time.
• Healthcare Databases Act, in which Cervical Cancer Screening Registry is mentioned, is passed into law.

2001

• Rules concerning requirements to be met by the laboratories examining the cervical smears becomes legal.

2002

• Ministry of Health published Rules on carrying out preventive health care at the primary level, which includes article 2 on reproductive healthcare. This makes future transition from a project to an organized screening programme on a national level possible.
• Publication of the Instructions for standardised reporting of cervical cytology results and information system for gynaecologic cytopathology.

2003

• European Council recommendations on cancer screening are published.
• National Cervical Cancer Screening Programme ZORA is established. Nineteen cytopathology laboratories/individuals who are assessing cervical smears take part in it.
• Standardised form for reporting cervical cytology results is introduced.

2004

• Rules concerning requirements to be met by the laboratories examining the cervical smears are accepted.
• ZORA register is complemented with cervical histopathology results, including hysterectomies.
• The first annual report of the National Cervical Cancer Screening Programme ZORA for years 2003–2004 is issued.
• Personal performance reports for NP ZORA providers are issued for the first time.

2005

• Information system methodological rules for cervical cytology results reporting are published.
• Rules for cervical screening and implementation of the National Cervical Cancer Screening Programme ZORA (4th edition) are published.
• Renewed Instructions for standardised reporting of cervical cytology results and information system for gynaecologic cytopathology are issued.

2006

• NP ZORA reached 70% examination coverage.
• The Papanicolaou classification was discontinued and a modified terminology of cervical cytopathology, which resembled the Bethesda classification, was implemented.
• Guidelines for holistic management of women with precancerous lesions of cervix are published.
• All women suitable for invitation in the whole country were invited at least once.
• First million of cervical screening exams is recorded.

2007

• Nine cytopathology laboratories take part in NP ZORA.

2008

• The second edition of European guidelines for quality assurance in cervical cancer screening are published.
• Rules of Procedure of the work of The Programme Council of NP ZORA are published.
• Cervical screening test results of women who had cervical cancer in the year 2006 were audited.

2009

• Nightly synchronisation of data from Central Population Register and Register of Spatial Units is implemented.

2010

• Implementation of HPV triage test (reflex HPV testing) takes place, accompanied with a form of consent. ZORA register is complemented with HPV test results.
• First Educational Day of the ZORA Program with international participation takes place.
• National Cancer Control Programme was formed.
• Cytology workshop is organised and a new standardised referral and report form, adapted by the Bethesda classification, is first introduced.

2011

• New standardised referral and report form, adapted by the Bethesda classification, is used on a national level.
• Rules for gynaecologists working in National Cervical Cancer Screening Programme ZORA are published.
• Information system methodological rules for HPV test results reporting are published.
• Information system methodological rules for cervical cytology reporting are updated.
• Rules for cervical cytology reporting by the Bethesda classification are updated.
• Guidelines for holistic management of women with precancerous lesions of cervix are updated.

2012

• Guidelines for holistic management of women with cervical cancer and Procedures for holistic manegement of women with cervical cancer are published.

2015

• Supplements to the European guidelines for quality assurance in cervical cancer screening are published.
• Start of a self-sampling project for nonresponders to the National Cervical Cancer Screening Programme ZORA in regions of Maribor and Celje.
• Guidelines for standardization of procedures and reporting of histopathological results in gynecological pathology - cervical neoplasia are published.
• European »8th Annual Tutorial of Cytopathology« takes place in Slovenia.

2016

• Standardised form for reporting cervical cytology results is updated.
• First e-course for diagnostic cervical cytology and patology is organised.
• Diagnostic cervical cytology and pathology workshop takes place at Faculty of Medicine in Ljubljana.
• Contemporary cervical cancer screening solutions, a workshop with international participation, is held by the National cervical cancer screening programme ZORA.
• National Cervical Cancer Screening Programme ZORA expert groups are formed in the fields of: gynecology, cytopathology, molecular diagnostics, histopathology, epidemiology, informatics and implementation.

2017

• Year when the lowest number of new cervical cancer cases of is reported (85).
• The concept of the renewal of the Information system of NP ZORA is publicly presented on the 7th Educational Day of the ZORA Program for the first time.
• Project business case for the Renewal of the information system of the National cervical cancer screening programme ZORA is published.
• 7th Educational Day of the ZORA Program with international participation takes place and a baseline for the renewal of screening policy of the National cervical cancer screening programme ZORA is discussed.
• 29 out of 30 cytoscreeners who cooperate in the NP ZORA passed the QUATE exam and obtained a certificate of competence by the European Federation of Cytology.
• First pilot scheme of quality assurance in pathology with digital slides is conducted.
• A booklet for women titled »What do you need to know about HPV?« is issued.

2018

• Dr. Urška Ivanuš is named Head of National Cervical Cancer Screening Programme and Registry ZORA.
• Act Amending the Healthcare Databases Act enters into force.
• Rules on the implementation of national screening programmes for the early detection of precancerous changes and cancer are applied.
• Form of consent for triage HPV test is no longer in use.
• Problems in assesment of cervical screening tests - experience after 10 years of revision of cervical screens of patients with cervical cancer workshop takes place.
• A booklet for women titled »Colposcopy procedure« is issued.

2019

• World Health Organization calls to action to eliminate cervical cancer.
• Guidelines for holistic management of women with cervical cancer and Procedures for holistic manegement of women with cervical cancer are updated.
• Members of the new Scientific Council of National Cervical Cancer Screening Programme and Registry ZORA are named.
• The website of the National Cervical Cancer Screening Programme and Registry ZORA is made accesible for blind and visually impaired people.

2020

• Due to COVID-19 pandemic, all preventive health services, including cervical cancer screening, are momentarily stopped by the Government (March 12th–May 8th 2020).
• World Health Organization launches a global strategy for cervical cancer elimination. Countries over the world illuminated their landmarks in colour teal, which is the colour of cervical cancer awareness. Slovenia was recognised as an example of good practice by the WHO.
• A booklet for women titled »Treatment of precancerous lesions of cervical cancer« is published.
• Post of Slovenia issues postmarks of all three National cancer screening programmes: ZORA, DORA and SVIT.