PCN220 HUMAN RESOURCES FOR CERVICAL CANCER SCREENING IN JAPAN: WHO SHOULD TAKE PAP SMEARS FOR CERVICAL CANCER SCREENING?

Abstract

Although cervical cancer screening has been performed as a national program since 1983 in Japan, taking Pap smears from the cervix has usually been performed by gynecologists and obstetricians in their offices. Conventionally, general physicians and midwives cannot take Pap smears of cervical cancer screening. Accessibility is one of the important factors to consider when planning to increase the participation rate in cancer screening programs. Gynecologists also play a primary role in the diagnosis and treatment for cervical cancers. Discussions regarding the needed resources for cancer screening programs have remained scare in Japan. We examined the number of gynecologists and obstetricians based on a national survey and performed a systematic review regarding accessibility to cervical cancer screening. 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. However, 43.6% of municipalities have no gynecologists and obstetricians in 2016. Four articles identified from Ovid-MEDLINE and Igaku-Chuo Zasshi were eligible and assessed. Two Japanese studies showed consistent results regarding the association of resources as gynecologists and obstetricians with participation rates in cervical cancer screening. Another article reported on the national distribution of gynecological oncologists and compared the treatment outcomes between hospitals with and without certified gynecologists. The number of certified gynecological oncologists has remained insufficient with a biased distribution. Thus, the survival rate of cervical cancer patients was different between hospitals with and without accreditation by an academic society. The human resources for taking Pap smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. Enabling general physicians to take Pap smears or introduction of self-sampling HPV testing may be considered to augment the limited access to cervical cancer screening.