Quality Of Cervical Screening Research Articles

Cervical screening in Denmark – a success followed by stagnation

Introduction: Despite an intensive screening activity, the incidence of cervical cancer in Denmark has remained stable for the last 15 years, while regional differences have increased. To search for explanations, we investigated possible weaknesses in the screening program.Material and methods: Data on the screen-targeted women were retrieved from Statistics Denmark. Data on screening activity were retrieved from the annual reports from 2009 to 2015 on quality of cervical screening. Coverage was calculated as proportion of screen-targeted women with at least one cytology sample within recommended time intervals. Insufficient follow-up was calculated as proportion of abnormal and unsatisfactory samples not followed up within recommended time intervals. Diagnostic distribution was calculated for samples with a satisfactory cytology diagnosis.Results: Coverage remained stable at 75%–76% during the study period. Annually, approximately 100,000 women are screened before they are eligible for invitation, and 600,000 invitations and reminders are issued resulting in screening of 200,000 women. In 2009, 21% of abnormal and unsatisfactory samples were not followed up within the recommended time interval; a proportion that had decreased to 15% in 2015. Overall, 11% of satisfactory samples with a cytology diagnosis were abnormal, but with surprising variation from 6% to 15% across regions.Discussion: The success of a screening program depends first of all on coverage and timely follow-up of abnormal findings. Our analysis indicated that the currently high incidence of cervical cancer in Denmark may partly be due to low screening coverage. Also worrisome is a high proportion of non-timely follow-up of abnormal findings. Innovative ways to improve coverage and follow-up are urgently needed.

Dramatic increase in cervical cancer registrations in young women in 2009 in England unlikely to be due to the new policy not to screen women aged 20–24

To explore whether the 17% increase in cervical cancer in England in 2009 was due to the change in cervical screening policy. Trends in incidence of cervical cancer and of cervical intraepithelial neoplasia grade 3 (CIN3) were analysed for England, Wales and Scotland. Invasive cervical cancer data on 4079 cancers in women aged 20-39 diagnosed between April 2007 and August 2011 in England were analysed by single year of age. In England there was a 38% (95% confidence intervals [CI] 18-62%) increase in cervical cancer incidence rates in women aged 25-29 in 2009 relative to 2008, and a 30% (11-51%) increase in women aged 35-39. Compared rates in 2010 are similar to those in 2008. The average increase between 2000 and 2010 in women aged 25-29 was no greater in England than in Scotland and Wales (relative risk 0.98, 95% CI 0.69-1.39). In England there has been a gradual increase in CIN3 (particularly for ages 25-29) since 2003, with a more dramatic increase in 2009, but a fall in 2010. Audit data showed an increase in cancers diagnosed at age 25 in 2009/2010 and 2010/2011 (P ≤ 0.0004). No increase was observed at age 26. For ages 27-29 an increase in cancer was observed for 2008/2009-2009/2010 when compared with 2007/2008-2010/2011 (P < 0.00001), but linear trends were not significant. The increase in cervical cancer in England in 2009 cannot be attributed to the lack of screening of women aged 20-24, or to a general decrease in the coverage or quality of cervical screening.

Commentary on Lauder W, Mummery K &amp; Sharkey S (2006) Social capital, age and religiosity in people who are lonely. Journal of Clinical Nursing15, 334–340

Nichols S (1987) Women’s preferences for sex of doctor: a postalsurvey. Journal of Royal College of General Practitioners 37, 540–543.Orbell S, Crombie I, Robertson A, Johnston G & Kenicer M (1995)Assessing the effectiveness of a screening campaign: who is missedby the 80% screening coverage. Journal of the Royal MedicalSociety 88, 389–395.Peto J, Gilham C, Fletcher O & Matthews FE (2004) The cervicalcancer epidemic that screening has prevented in the UK. TheLancet 346, 249–256.Stirland H, Husain OAN, Butler EB, Cater S & Russel KS (1996)Cervical screening in the inner cities: is the opportunistic approachstill worthwhile? British Medical Journal 313, 600.Summers A & Fullard B (1995) Improving the coverage and qualityof cervical screening: women’s views. Journal of Public HealthMedicine 17, 277–281.Vella PV (1991) A survey of women undergoing a pelvic examina-tion. Australian New Zealand Journal of Obstetrics and Gynae-cology 31, 355–357.

Quality of cervical screening in the well woman clinics in Kalutara District

Quality of cervical screening in the well woman clinics in Kalutara District

Improving the coverage and quality of cervical screening: women's views

Improving the coverage and quality of cervical screening: women's views