Effectiveness of the National Population-Based Cervical Cancer Screening Programme in Poland--outcomes, problems and possible solutions 7 years after implementation.

Cervical cancer is a substantial issue for public health in Poland. In 2006, in order to improve epidemiological data, the National Population-Based Cervical Cancer Screening Programme was developed and implemented. The Programme concerned 9.7 million women aged 25-59 to be screened during a 3-year interval. In 2010, a decline in cervical cancer incidence by 5.7% and 3.4% in mortality rate was observed. However, 5-year survival rates do not exceed 51%. Attendance rate reached 27%, then fell and presently remains on the level of 24%. Currently, the main concern for the screening organizers is searching for areas malfunctioning in local conditions, to improve them, and to provide further progress in cervical cancer prevention. The objective of the presented study was to critically review available data concerning the outcomes of the Screening Program and to suggest possible solutions. Two main factors were taken into account in the study: cost-effectiveness and attendance rate. To encourage attendance, women in Poland are sent personal invitations. This procedure consumes from a quarter up to a half of the budget of the Programme each year, but its effectiveness seems unsatisfactory. In addition to mailing, intensive training of doctors and midwives is conducted. Other activities to increase coverage include developing a social educational campaign. According to the Polish experience, the most effective way to increase coverage is training screening providers and involving them actively in encouraging screening participation. Thus, redistribution of funds from mailing to education and to a social campaign should be considered. Further development of cervical cancer prevention may depend on organizational changes including enhancing reporting, monitoring and quality control in opportunistic screening.