Májek Ondřej, Dušková Jaroslava, Dvořák Vladimír, Beková Alena, Klimeš Daniel, Blaha Milan, Anttila Ahti, Dušek Ladislav
aInstitute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University bCentre of Outpatient Gynaecology and Primary Care, Brno cInstitute of Health Information and Statistics dInstitute of Pathology, 1st Faculty of Medicine, Charles University eCGOP, Prague, Czech Republic fFinnish Cancer Registry, Helsinki, Finland.
Eur J Cancer Prev. 2017 May;26(3):232-239. doi: 10.1097/CEJ.0000000000000236.
In 2008, the organized Czech National Cervical Cancer Screening Programme (CNCCSP) was initiated by transformation of the existing opportunistic efforts. The aim of our study was to examine recent cervical cancer burden trends and to assess the quality of the Czech National Cervical Cancer Screening Programme using a set of standard performance indicators. Our study utilized data from the national Cervical Cancer Screening Registry and the Czech National Cancer Registry. We computed internationally accepted indicators and assessed time trends and variability among screening centres. Between 1995 and 2011, the incidence of age-standardized cervical cancer decreased by 21% (1023 cases in 2011), and the mortality decreased by 35% (399 deaths in 2011). The annual coverage of the target population by cervical screening increased to 56% in 2013 (as compared with 35% in 2001). If we consider a 2-year interval (2012-2013), the estimated coverage was 77%. Over two million women underwent screening in 2013; 96% of them had a negative result. About 0.2% of smears showed cytological signs of a high-grade intraepithelial lesion or a malignancy, and the estimated positive predictive value for advanced intraepithelial neoplasia (cervical intraepithelial neoplasia grade 2+) was 79.6%. However, performance indicators show considerable heterogeneity between screening centres. The reported values of performance indicators are in line with the results of programmes that have previously been shown to be successful in terms of decreasing the cervical cancer burden, and are promising with respect to an even more pronounced decrease in cervical cancer mortality in the near future, provided that continuous quality improvement can be maintained. Linkage studies between screening, cancer and cause-of-death registers can provide further information on screening effectiveness and validity issues.
2008年，捷克通过整合现有的机会性筛查工作，启动了有组织的国家宫颈癌筛查计划（CNCCSP）。我们研究的目的是利用一组标准绩效指标，研究近期宫颈癌负担趋势，并评估捷克国家宫颈癌筛查计划的质量。我们的研究使用了国家宫颈癌筛查登记处和捷克国家癌症登记处的数据。我们计算了国际认可的指标，并评估了筛查中心之间的时间趋势和变异性。1995年至2011年期间，年龄标准化宫颈癌发病率下降了21%（2011年为1023例），死亡率下降了35%（2011年为399例死亡）。2013年，宫颈癌筛查目标人群的年度覆盖率提高到56%（2001年为35%）。如果我们考虑2年的时间间隔（2012 - 2013年），估计覆盖率为77%。2013年有超过200万妇女接受了筛查；其中96%的结果为阴性。约0.2%的涂片显示有高级别上皮内病变或恶性肿瘤的细胞学迹象，高级别上皮内瘤变（宫颈上皮内瘤变2级及以上）的估计阳性预测值为79.6%。然而，绩效指标显示筛查中心之间存在相当大的异质性。所报告的绩效指标值与之前在降低宫颈癌负担方面已被证明成功的项目结果一致，并且如果能够持续保持质量改进，在不久的将来有望使宫颈癌死亡率进一步显著下降。筛查、癌症和死亡原因登记处之间的关联研究可以提供关于筛查有效性和效度问题的更多信息。
