Abstract
Background:Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a basic requirement for cancer screening. However, taking smears from the cervix has been limited to gynecologists or obstetricians in Japan and it might be a barrier for accessibility. We examined the current access and its available human resources for cervical cancer screening in Japan. Methods:We analyzed the number of gynecologists and obstetricians among 47 prefectures based on a national survey. A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2020. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables. Results:Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. 43.6% of municipalities have no gynecologists and obstetricians in 2016. Through a systematic review, 4 English articles and 1 Japanese article were selected. From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles. Conclusions:The human resources for taking smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers.
Highlights
Cervical cancer screening has commonly performed worldwide because of the heavy burden of the disease
Human resources for cervical cancer screening From 1996 to 2016, the total number of all physicians increased; for two decades, the proportion of gynecologists and obstetricians has remained at approximately 5% (Figure 1) (Ministry of Health, Labour and Welfare, 2020-a)
Based on the national survey, a huge disparity was recognized in the human resources of cervical cancer screening
Summary
Cervical cancer screening has commonly performed worldwide because of the heavy burden of the disease. Similar trends of mortality from cervical cancer have been observed in developed countries (IARC, 2020) Most of these developed countries have established national programs for cervical cancer screening and have maintained high participation rates (Elfström et al, 2015). Cervical cancer screening has been performed as a national program in Japan since 1983 (Hamashima, 2018), the participation rate has remained lower than those of other developed countries (OECD and European Union, 2018). A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. 4 English articles and 1 Japanese article were selected From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers
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