Januszek-Michalecka Lucyna, Nowak-Markwitz Ewa, Banach Paulina, Spaczynski Marek
Department of Gynaecologic Oncology, Poznan University of Medical Sciences, Poland.
Ann Agric Environ Med. 2013;20(4):859-64.
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.
宫颈癌是波兰公共卫生领域的一个重大问题。2006年，为了改善流行病学数据，制定并实施了全国基于人群的宫颈癌筛查计划。该计划涉及970万年龄在25至59岁之间的女性，她们将在3年的间隔期内接受筛查。2010年，观察到宫颈癌发病率下降了5.7%，死亡率下降了3.4%。然而，5年生存率不超过51%。参与率达到27%，随后下降，目前仍维持在24%的水平。目前，筛查组织者主要关注的是寻找在当地条件下运作不畅的领域，加以改进，并在宫颈癌预防方面取得进一步进展。本研究的目的是批判性地回顾有关筛查计划结果的现有数据，并提出可能的解决方案。研究中考虑了两个主要因素：成本效益和参与率。为鼓励参与，波兰向女性发送个人邀请。这一程序每年消耗该计划预算的四分之一到一半，但效果似乎并不理想。除了邮寄之外，还对医生和助产士进行强化培训。其他提高覆盖率的活动包括开展社会教育运动。根据波兰的经验，提高覆盖率最有效的方法是培训筛查提供者，并让他们积极参与鼓励筛查参与。因此，应考虑将资金从邮寄重新分配到教育和社会运动。宫颈癌预防的进一步发展可能取决于组织变革，包括加强机会性筛查中的报告、监测和质量控制。
