‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

Abstract

Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies.

Canadian Cancer Screening Disparities: A Recent Historical Perspective

“…For a few cancers, screening tests for average-risk populations, when available and implemented in population-based programs for asymptomatic individuals, can in and of themselves lead to reduced cancer mortality [3][4][5] . Although organized screening programs are able to deliver services more efficiently and more equitably, it recognized that in most countries, the meaning of "organized screening" varies widely and therefore includes a mix of organized and opportunistic screening 6 .…”

Cervical cancer prevention: An Italian scenario between organised screening and human papillomaviruses vaccination

“…Shifting towards HPV‐based cervical screening have recently implemented in Italy, according to the Ministry of Health recommendations and guidelines for its application (stand‐alone HPV testing by validated methods, cytological triage of HPV positives, beginning at age 30–35, 5‐year intervals) (Italian Ministry of Health, ). A future challenge for the organisation of cervical screening is to link it to this new context of efforts to vaccinate young people against HPV infection (Williams, Carter, & Rychetnik, ). By linking vaccination, cervical screening and HPV testing data, we will be able to estimate the decline in high‐risk HPV vaccine types and nonvaccine types closely related to HPV16/18 (for cross‐protection), herd immunity among nonvaccinated females and sustained effectiveness of the vaccines on virologic outcomes at the population level (Cameron et al., ).…”

“…Paradigms for cervical cancer screening are changing in highresource settings, including Italy, from cytology-based screening to adoption of molecular screening (von Karsa et al, 2015;Pimple, Mishra, & Shastri, 2016 (Williams, Carter, & Rychetnik, 2014). By linking vaccination, cervical screening and HPV testing data, we will be able to estimate the decline in high-risk HPV vaccine types and nonvaccine types closely related to HPV16/18 (for cross-protection), herd immunity among nonvaccinated females and sustained effectiveness of the vaccines on virologic outcomes at the population level (Cameron et al, 2016).…”

A survey of cervical screening among refugee and non‐refugee African immigrant women in Brisbane, Australia

“…This approach, however, needs to be investigated further as there is no clear evidence of how co-existing opportunistic and organised screening influence each other. 10 This survey has several limitations that should be considered when interpreting the results. First, participants were not randomly sampled and the study was limited to a modest sample size and a single urban location.…”

“…Nevertheless, organised screening has the potential to achieve greater participation by women because it enhances the chances that all women will access cervical screening services. 10 Organised cervical screening programs in low-income countries, however, are non-existing or have not been as successful. 4,11,12 In most developing countries cervical screening starts as opportunistic or ad hoc; 13,14 unlike organised cervical screening, opportunistic screening is initiated by health professionals upon personal contact with patients at a primary health centre or any healthcare setting.…”