In the current 28 Member States of the European Union (EU), approximately 34,000 new cases of cervical cancer and 13,500 deaths from the disease occur annually. Despite significant progress, incidence and mortality rates are still high in many of the Member States and there are countries with no clear decrease in cervical cancer burden even if screening practised in large scale. The current variation in cervical cancer burden largely reflects inadequate implementation of cervical cancer screening programmes.
The European quality assurance guidelines recommend systematic linkages between screening, cancer registry and mortality records. When screening data can be linked with the cancer incidence and mortality records, a comprehensive audit of the entire screening programme can be performed. The presentation discusses key entities in these audits in relation with screening outcome (1).
Each case of cancer should be investigated, i.e., cancers in both screened and unscreened women. Key areas of potential errors in screening affecting cancer burden are
- Whether the target age defined and women invited properly and with appropriate intervals
- If women remain unscreened or underscreened – even though a large proportion of the population may be screened too frequently
- Whether sampling or diagnostic errors in screening test, triage or confirmation
- Were there management errors in pre-cancer cases; e.g. drop-out prior to management or in the management follow-up after the primary excision treatment
- If not optimal treatment of cancer.
Registry-based audit should be carried out for any technologies that are implemented in the programme. In attended women, re-review of negative screening tests of subsequent cases, seeded in a relevant set of controls allow further distinction between reasons for potential false negative diagnoses simultaneously with information on the specificity in re-reading.
An important element of the audit is to monitor the programme policies and service providers over the long term, to demonstrate whether the quality assurance activity contributed to any additional improvement in effectiveness.
(1) Anttila A, Ronco G, Lynge E, et al. Epidemiological guidelines for quality assurance in cervical cancer screening. In: Arbyn M, Anttila A, Jordan J, et al., eds. European guidelines for quality assurance on cervical cancer screening. 2 ed. Brussels: European Community, February 2008.