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The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines.

Nowakowski A, Cybulski M, Śliwczyński A, Chil A, Teter Z, Seroczyński P, Arbyn M, Anttila A - BMC Cancer (2015)

Bottom Line: Available data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG.The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw 44, Poland. andrzejmnowakowski@poczta.onet.pl.

ABSTRACT

Background: Well-organised quality-controlled screening can substantially reduce the burden of cervical cancer (CC). European guidelines (EuG) for quality assurance in CC screening provide guidance on all aspects of an organised screening programme. Organised CC screening in Poland was introduced in 2007. The purpose of our study was to analyse: (i) adherence of the programme to EuG; (ii) programme process and performance indicators; (iii) impact of the programme on the incidence of and mortality from CC.

Methods: Available data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG. Data on the process, and available performance indicators were drawn from the screening database and other National Health Fund (NHF) systems. Joinpoint regression was used to assess changes in CC incidence and mortality trends.

Results: The Polish programme adheres partially to EuG in terms of policy and organisation. Only a limited set of performance indicators can be calculated due to screening database incompleteness or lack of linkage between existing databases. The screening database does not include opportunistic smears collected within NHF-reimbursed or private care. The organised programme coverage rate fluctuated from 21% to 27% between 2007-2013. In 2012 the coverage reached 35% after combining both organised and opportunistic smears reimbursed by the NHF. In 2012 the number of smears reimbursed by NHF was 60% higher in opportunistic than in organised screening with significant overlap. Data from the private sector are not recorded. Depending on years, 30-50% of women referred for colposcopy/biopsy because of abnormal Pap smears were managed within the programme. The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.

Conclusions: The Polish organised cervical screening programme is only partially adherent to evidence-based EuG. Its implementation has not influenced the burden of CC in the country so far. Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness. Our findings may be useful to improve the Polish programme and those implemented or planned in other countries.

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Related in: MedlinePlus

World age-standardised rates of incidence of and mortality from cervical cancer in Poland (1999-2011). Figure legend: ASIR - Age-Standardised Incidence Rate; ASMR - Age-Standardised Mortality Rate; ^ - The Annual Percent Change (APC) is significantly different from zero; 95% CI - 95% confidence interval.
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Fig2: World age-standardised rates of incidence of and mortality from cervical cancer in Poland (1999-2011). Figure legend: ASIR - Age-Standardised Incidence Rate; ASMR - Age-Standardised Mortality Rate; ^ - The Annual Percent Change (APC) is significantly different from zero; 95% CI - 95% confidence interval.

Mentions: Both age-standardised CC incidence and mortality rates have been decreasing steadily for the last decade in Poland (Figure 1). Figure 2 shows the age-standardised incidence rates (ASIR), and mortality rates (ASMR), as well as the annual percentage change (APC) with 95% CIs for CC in Poland (1999-2011). The declines in both standardised rates decreased significantly in the period 1999-2011 with the APC for incidence: -2.6, 95% CI: -3.1 to - 2.1 and the APC for mortality: -2.2, 95% CIN: -2.8 to -1.7 (Figure 2). The decreases in incidence were significant in all 10-year age groups apart from women aged 60-69 years (Figure 2). The age-specific mortality rates dropped significantly in all age groups apart from women aged 50-59 and 60-69 years (Figure 2). The linear slopes were constant in all age groups and no significant trend changes were identified over the analysed period (1999-2011) encompassing implementation of the programme (2006/2007) (Figure 2).Figure 1


The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines.

Nowakowski A, Cybulski M, Śliwczyński A, Chil A, Teter Z, Seroczyński P, Arbyn M, Anttila A - BMC Cancer (2015)

World age-standardised rates of incidence of and mortality from cervical cancer in Poland (1999-2011). Figure legend: ASIR - Age-Standardised Incidence Rate; ASMR - Age-Standardised Mortality Rate; ^ - The Annual Percent Change (APC) is significantly different from zero; 95% CI - 95% confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4417537&req=5

Fig2: World age-standardised rates of incidence of and mortality from cervical cancer in Poland (1999-2011). Figure legend: ASIR - Age-Standardised Incidence Rate; ASMR - Age-Standardised Mortality Rate; ^ - The Annual Percent Change (APC) is significantly different from zero; 95% CI - 95% confidence interval.
Mentions: Both age-standardised CC incidence and mortality rates have been decreasing steadily for the last decade in Poland (Figure 1). Figure 2 shows the age-standardised incidence rates (ASIR), and mortality rates (ASMR), as well as the annual percentage change (APC) with 95% CIs for CC in Poland (1999-2011). The declines in both standardised rates decreased significantly in the period 1999-2011 with the APC for incidence: -2.6, 95% CI: -3.1 to - 2.1 and the APC for mortality: -2.2, 95% CIN: -2.8 to -1.7 (Figure 2). The decreases in incidence were significant in all 10-year age groups apart from women aged 60-69 years (Figure 2). The age-specific mortality rates dropped significantly in all age groups apart from women aged 50-59 and 60-69 years (Figure 2). The linear slopes were constant in all age groups and no significant trend changes were identified over the analysed period (1999-2011) encompassing implementation of the programme (2006/2007) (Figure 2).Figure 1

Bottom Line: Available data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG.The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw 44, Poland. andrzejmnowakowski@poczta.onet.pl.

ABSTRACT

Background: Well-organised quality-controlled screening can substantially reduce the burden of cervical cancer (CC). European guidelines (EuG) for quality assurance in CC screening provide guidance on all aspects of an organised screening programme. Organised CC screening in Poland was introduced in 2007. The purpose of our study was to analyse: (i) adherence of the programme to EuG; (ii) programme process and performance indicators; (iii) impact of the programme on the incidence of and mortality from CC.

Methods: Available data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG. Data on the process, and available performance indicators were drawn from the screening database and other National Health Fund (NHF) systems. Joinpoint regression was used to assess changes in CC incidence and mortality trends.

Results: The Polish programme adheres partially to EuG in terms of policy and organisation. Only a limited set of performance indicators can be calculated due to screening database incompleteness or lack of linkage between existing databases. The screening database does not include opportunistic smears collected within NHF-reimbursed or private care. The organised programme coverage rate fluctuated from 21% to 27% between 2007-2013. In 2012 the coverage reached 35% after combining both organised and opportunistic smears reimbursed by the NHF. In 2012 the number of smears reimbursed by NHF was 60% higher in opportunistic than in organised screening with significant overlap. Data from the private sector are not recorded. Depending on years, 30-50% of women referred for colposcopy/biopsy because of abnormal Pap smears were managed within the programme. The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.

Conclusions: The Polish organised cervical screening programme is only partially adherent to evidence-based EuG. Its implementation has not influenced the burden of CC in the country so far. Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness. Our findings may be useful to improve the Polish programme and those implemented or planned in other countries.

Show MeSH
Related in: MedlinePlus