title: Process performance of cervical screening programmes in Europe.
abstract: Standardised tables of aggregated data were collected from 15 European national or regional cervical screening programmes and key performance indicators computed as reported in European Union (EU) Guidelines, 2nd edition. Cytological results varied widely between countries both for the total proportion of abnormal tests (from 1.2% in Germany (Mecklenburg-Vorpommern) to 11.7% in Ireland-Midwest Region) and for their distribution by grade. Referral rates for repeat cytology (ranging from 2.9% of screened women in the Netherlands to 16.6% in Slovenia) or for colposcopy (ranging from 0.8% in Finland to 4.4% in Romania-Cluj) and the Positive Predictive Value (PPV) of colposcopic attendance (ranging from 8% in Romania-Cluj to 52% in Lithuania) were strongly influenced by management protocols, in particular for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology. However, cytology-specific PPV also showed remarkable variability. The detection rate of CIN2+ histology ranged from <0.1% of screened women in Poland to >1% in England and Denmark. Low attendance for colposcopy after referral was observed in some east-European countries. These comparisons may be useful for improving the performance of cervical screening in general and more so if new screening technologies and vaccination for Human Papillomavirus are introduced. Overall, quality was better in countries that have operated organised programmes for a longer time, plausibly as a result of long-lasting monitoring and quality assurance activities. Therefore, the availability of these data, the first comparing European countries, and the increased number of countries that can provide such data (only five in 2004) represent progress. Nevertheless, there is a clear need to standardise the cytological and histological classifications used in screening, as well as data registration systems across Europe.
authors.affiliation: Unit of Cancer Epidemiology, Centre for Cancer Prevention , Via San Francesco da Paola 31, 1023 Torino, Italy. guglielmo.ronco@cpo.it
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Ronco
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Chil
authors.forename: Muriel
authors.initials: M
authors.lastname: Fender
authors.forename: Pamela
authors.initials: P
authors.lastname: Giubilato
authors.forename: Juozas
authors.initials: J
authors.lastname: Kurtinaitis
authors.forename: Lesz
authors.initials: L
authors.lastname: Lancucki
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.forename: Antonio
authors.initials: A
authors.lastname: Morais
authors.forename: Marian
authors.initials: M
authors.lastname: O'Reilly
authors.forename: Pär
authors.initials: P
authors.lastname: Sparen
authors.forename: Ofelia
authors.initials: O
authors.lastname: Suteu
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
authors.forename: Piret
authors.initials: P
authors.lastname: Veerus
authors.forename: Maja Primic
authors.initials: MP
authors.lastname: Zakelj
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
mesh_terms: D000328:Adult; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000517:prevention & control*