Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Yann De Rycke,Christine Bergeron,Mathieu Uhart,Charlotte Cancalon,Audrey Lajoinie,Marie Dalichampt,Hélène Borne,Xavier Bresse,André Dahlab,Sylvie Guillo,Florence Tubach,Stève Bénard,Alexandre Lafourcade

doi:10.1371/journal.pone.0228660

Abstract

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d’information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

Highlights

Christine Bergeron and Helène Borne have been rewarded by SPMSD / MSD Vaccins as members of the study Independent Scientific Committee
This corresponds to a total number of 10,847,814 women with at least one smear test performed for the whole female population over the recommended 3-year interval, corresponding to 4,906,170–4,901,131 and 4,758,381 women in 2012, 2013 and 2014, respectively
The present study focused on outpatient and in-hospital diagnosis investigations and therapeutic management of squamous intraepithelial lesions (SIL) lesions; the management of potentially human papillomavirus (HPV)-related cancers has already been assessed within a first observational study based on the French Système National des Donnees de Sante (SNDS) [31]

Summary

Introduction

Xavier Bresse is an employee of MSD vaccins. SPMSD / MSD Vaccins were involved in the study design, data analysis, decision to publish, and preparation of the manuscript. Stève consultants did not fund the study but was in charge of designing and performing the study. Yann de Rycke, Florence Tubach, Alexandre Lafourcade, Sylvie Guillo and Marie Dalichampt received no specific funding for this work. Christine Bergeron and Helène Borne have been rewarded by SPMSD / MSD Vaccins as members of the study Independent Scientific Committee

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