Screening of cervical cancer in Catalonia 2006–2012

Abstract

The early detection of intraepithelial lesions of the cervix, through the periodic examination of cervical cells, has been fundamental for the prevention of invasive cervical cancer and its related mortality. In this report, we summarise the cervical cancer screening activities carried out in Catalonia, Spain, within the National Health System during 2008–2011. The study population covers over two million women resident in the area. The evaluation includes 758,690 cervical cytologies performed on a total of 595,868 women. The three-year coverage of cervical cytology among women aged between 25 and 65 years was 40.8%. About 50% of first screened women with negative results had not returned to the second screening round. The introduction of high-risk human papillomavirus DNA (HPV) detection, as a primary screening cotest with cytology among women over age 40 with a poor screening history, significantly improved the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), being far superior to cytology alone. Cotesting did not improve the detection of CIN2+. The use of the HPV test for the triage of atypical squamous cell undetermined significance (ASC-US) improved the selection of women at high risk of CIN2+.Sampling (both cytology and HPV test) was largely performed by midwives (66.7%), followed by obstetricians (23.8%) and nurses (7%). Over half of the centres (54.8%) had full use of online medical records. During the study period, educational activities for professionals and for women were carried out periodically.The organisation of screening as a population activity in which women are actively called to the screening visit and the introduction of HPV testing as a primary screening tool are strongly recommended to ensure the maximum population impact in the reduction of the cervical cancer burden.

Decline of mortality from cervical cancer

“…Despite the decrease, the average rate found in the study was higher than that of Brazil (4) . There is a consensus in the literature that population screening for cervical cancer is the most important public health strategy because it reduces the incidence and, subsequently, mortality by identifying pre-invasive and invasive lesions in early stages, enabling a more effective treatment (14)(15) .…”

Long-term protection of HPV test in women at risk of cervical cancer

“…This study is part of periodical evaluation reports on cervical cancer screening activities in the public health system in Catalonia (Spain) carried out by the Catalan Institute of Oncology [22,23].…”

The diagnostic accuracy of a real-time optoelectronic device in cervical cancer screening

“…The ThinPrep cytologic test (TCT), the HPV test, and the combined test (TCT & HPV) all have high sensitivity and specificity. [ 24 ] However, these tests are expensive, require a high level of technological skill, and entail long waiting times to obtain results. Therefore, such tests may not be suitable for widespread use in the developing world.…”