title: Cervical cancer screening in Europe: Quality assurance and organisation of programmes.
abstract: BACKGROUND
  Cervical screening programmes have reduced cervical cancer incidence and mortality but the level of success is highly variable between countries. Organisation of programmes is essential for equity and cost-effectiveness. However, there are differences in effectiveness, also among organised programmes. In order to identify the key organisational components that determine effectiveness, we performed a Europe-wide survey on the current status of organisation and organised quality assurance (QA) measures in cervical cancer prevention programmes, as well as organisation-associated costs.
  
  
  METHODS
  A comprehensive questionnaire was developed through systematic review of literature and existing guidelines. The survey was sent to programme organisers, Ministries of Health and experts in 34 European Union (EU) and European Free Trade Agreement (EFTA) countries. Detailed aspects of programme organisation, quality assurance, monitoring, evaluation and corresponding line-item costs were recorded. Documentation of programme guidelines, protocols and publications was requested.
  
  
  RESULTS
  Twenty-nine of 34 countries responded. The results showed that organised efforts for QA, monitoring and evaluation were carried out to a differing extent and were not standardised, making it difficult to compare the cost-effectiveness of organisation and QA strategies. Most countries found it hard to estimate the costs associated with launching and operating the organised programme.
  
  
  CONCLUSIONS
  To our knowledge, this is the first questionnaire to request detailed information on the actual organisation and QA of programmes. The results of this survey can be used as a basis for further development of standardised guidelines on organisation and QA of cervical cancer screening programmes in Europe.
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden.
authors: K Miriam
authors: KM
authors: Elfström
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden.
authors: Lisen
authors: L
authors: Arnheim-Dahlström
authors: Quality Assurance Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France.
authors: Lawrence
authors: L
authors: von Karsa
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden. Electronic address: joakim.dillner@ki.se.
authors: Joakim
authors: J
authors: Dillner
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods / Q000592:standards*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: Cervical cancer screening; Guidelines; Health policy; Prevention; Quality assurance