An organised population-based cervical cancer screening was set up in 2013 in the Flemish Region for women aged 25 to 64, based on a call-recall system. Cytology is used as primary screening test and HPV detection as triage for atypical cells. The Belgian Cancer Registry (BCR) calculates yearly quality indicators to monitor this program on demand of the Agency for Care and Health of the Flemish Ministry of Welfare, Public Health and Family.
Besides new cancer diagnoses, the BCR collects all anatomo-pathological results of cervical samples in a central cyto-histopathology registry, which is completed with administrative data from health insurance companies. BCR plays a crucial role in the cost-effective organisation and the quality assurance of the screening program due to the centralisation of all these data and due to the possibility of linking at the personal level using a unique patient identifier. By linking these databases with a Flemish population registry, BCR calculated for 2013 several quality indicators.
In 2013, 64% of the Flemish female population between 25 and 64 years old was covered by the screening program. 7% of the eligible women had an abnormal screening. 27% of the women with an abnormal screening had no follow-up within one year. 236 new invasive tumours were diagnosed within the target population. Analysis of the screening history revealed that 111 of these tumours were diagnosed in women that were not screened within 5 years before. About 40% of the tumours in these non-screened women are stage I. In contrast, more than 70% of the women who had at least one screening in the last 5 years had a stage I tumour. 82 of the 236 women with an invasive tumour were tested for HPV in the past 5 year, whereof 10 with a negative HPV test result.
Quality indicators reveal the weaknesses in the screening program. They can be directly translated into policy decisions to increase the program coverage, to improve the follow-up rate after abnormal screening and to investigate whether or not these cancers are truly HPV negative. Centralisation of databases and the possibility of individual linking are crucial to a successful screening program.
Acknowledgements
The Agency for Care and Health, part of the Flemish Ministry of Welfare, Public Health and Family, finances the Flemish cervical cancer screening program. It subsidizes the Center for Cancer Detection to carry out the program and the BCR to support the organization and evaluation of the program.