Nowakowski Andrzej, Cybulski Marek, Śliwczyński Andrzej, Chil Arkadiusz, Teter Zbigniew, Seroczyński Przemysław, Arbyn Marc, Anttila Ahti
Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw 44, Poland.
Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodźki 1, 20-093, Lublin, Poland.
BMC Cancer. 2015 Apr 14;15:279. doi: 10.1186/s12885-015-1242-9.
Well-organised quality-controlled screening can substantially reduce the burden of cervical cancer (CC). European guidelines (EuG) for quality assurance in CC screening provide guidance on all aspects of an organised screening programme. Organised CC screening in Poland was introduced in 2007. The purpose of our study was to analyse: (i) adherence of the programme to EuG; (ii) programme process and performance indicators; (iii) impact of the programme on the incidence of and mortality from CC.
Available data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG. Data on the process, and available performance indicators were drawn from the screening database and other National Health Fund (NHF) systems. Joinpoint regression was used to assess changes in CC incidence and mortality trends.
The Polish programme adheres partially to EuG in terms of policy and organisation. Only a limited set of performance indicators can be calculated due to screening database incompleteness or lack of linkage between existing databases. The screening database does not include opportunistic smears collected within NHF-reimbursed or private care. The organised programme coverage rate fluctuated from 21% to 27% between 2007-2013. In 2012 the coverage reached 35% after combining both organised and opportunistic smears reimbursed by the NHF. In 2012 the number of smears reimbursed by NHF was 60% higher in opportunistic than in organised screening with significant overlap. Data from the private sector are not recorded. Depending on years, 30-50% of women referred for colposcopy/biopsy because of abnormal Pap smears were managed within the programme. The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.
The Polish organised cervical screening programme is only partially adherent to evidence-based EuG. Its implementation has not influenced the burden of CC in the country so far. Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness. Our findings may be useful to improve the Polish programme and those implemented or planned in other countries.
组织有序的质量控制筛查可大幅减轻宫颈癌（CC）负担。欧洲宫颈癌筛查质量保证指南（EuG）为有组织的筛查计划的各个方面提供指导。波兰于2007年引入了有组织的宫颈癌筛查。我们研究的目的是分析：（i）该计划对EuG的遵循情况；（ii）计划流程和绩效指标；（iii）该计划对宫颈癌发病率和死亡率的影响。
将波兰计划的政策、结构和运作的现有数据与EuG的要点进行比较。流程数据和可用的绩效指标来自筛查数据库和其他国家卫生基金（NHF）系统。采用连接点回归评估宫颈癌发病率和死亡率趋势的变化。
波兰计划在政策和组织方面部分遵循EuG。由于筛查数据库不完整或现有数据库之间缺乏关联，只能计算有限的一组绩效指标。筛查数据库不包括在NHF报销或私人护理中收集的机会性涂片。2007年至2013年期间，有组织的计划覆盖率在21%至27%之间波动。2012年，在将NHF报销的有组织和机会性涂片合并后，覆盖率达到35%。2012年，NHF报销的机会性涂片数量比有组织的筛查高60%，且有显著重叠。私营部门的数据未记录。因巴氏涂片异常而转诊进行阴道镜检查/活检的女性中，30%至50%在该计划内得到处理，具体比例因年份而异。1999年至2011年期间，年龄标准化的宫颈癌发病率和死亡率呈线性下降，没有明显的时期效应。
波兰有组织的宫颈癌筛查计划仅部分遵循基于证据的EuG。到目前为止，其实施尚未影响该国的宫颈癌负担。需要进行特别关注提高覆盖率、发展信息系统和质量评估的变革，以提高该计划对EuG的遵循程度并衡量其有效性。我们的研究结果可能有助于改进波兰的计划以及其他国家已实施或计划实施的计划。
