Screening for cervical cancer--should the routine be challenged?

Organised vs. spontaneous Pap-smear screening for cervical cancer: A case-control study

To compare the effect of organised pap-smear screening for cervical cancer with that of the spontaneous one on the incidence of invasive cervical cancer, we performed a case-control study within the catchment area of the Helsinki University Hospital (Helsinki, Finland). The study material consisted of 179 incident cases of invasive cervical cancer and 1,507 population controls. Data on lifetime pap smears before the year of the cancer diagnosis were collected using a self-administered questionnaire. The questionnaire information was obtained for 82% of the cases and 73% of the controls. The main outcome measure was relative risk of invasive cervical cancer among those with history of organised or spontaneous screening compared with risk among those with no history of screening for cervical cancer, measured as odds ratios (OR) with 95% confidence intervals (CI) and computed with logistic regression. Odds ratio of invasive cervical cancer among those who participated in the organised screening programme was 0.38 (CI 0.26-0.56) whereas any lifetime spontaneous pap smear had an OR value of 0.82 (CI 0. 53-1.26), in terms of unit risk for those not subjected to any screening and adjusted for age and the other type of the screening activity. Our results indicate that the substantial decrease in the incidence of and mortality due to cervical cancer in Finland is mainly due to the organised mass-screening.

Measurement of the Cost of Screening for Cervical Cancer in the District of Florence, Italy

AIMS AND BACKGROUND

To estimate the cost per woman examined and per CIN II or more severe lesion detected in a population-based cytologic screening program for cervical cancer prevention. An organized cytologic screening program has been ongoing in the Florence District since 1973, and a call-recall system using mail invitation has been ongoing since 1980. Smear reading and assessment of screening positives is centralized at the screening unit.

METHODS AND STUDY DESIGN

All relevant resources (costs) consumed by the program were listed and measured. The unit cost per examined woman and per each CIN II or more severe lesion detected was estimated for each screening phase (recruitment, screening, assessment).

RESULTS

The cost per examined woman was $24.60, whereas that per CIN II or more severe lesion detected was $13,600. Staff accounted for 80% of total amount.

CONCLUSIONS

Although the cost for a single procedure is low, the cost per detected lesion is quite remarkable due to the low detection rate in a population screened for a long time. Different approaches and longer interval screening tests are discussed.