Department of Global Health, School of Public Health, Peking University, Beijing, China.
Institute for Global Health and Development, Peking University, Beijing, China.
J Glob Health. 2024 Oct 25;14:04189. doi: 10.7189/jogh.14.04189.
Cervical cancer is a global health threat and a manifestation of inequality, and screening is an effective intervention. However, little is known about how screening coverage and quality assurance, influence cervical cancer mortality. We aimed to investigate the association between screening coverage, screening quality assurance and cervical cancer mortality among women from countries at different developmental levels.
We obtained data on age-standardised mortality from cervical cancer from the GLOBOCAN 2020 database; coverage of cervical cancer screening from World Health Organization (WHO) Global Health Observatory; and cervical screening programme settings and quality assurance from the Cancer Screening in Five Continents (CanScreen5) database. We assessed the dependency of cervical cancer age-standardised mortality on screening coverage and quality assurance by simple and multiple regression models. We also used linear regression models to identify factors that improved the screening coverage.
The study included data from 53 countries. Reduced mortality was associated with increased screening programme quality assurance in 22 high-development countries. In 31 low-development countries, screening coverage in women aged 30-49 years was inversely associated with cervical cancer mortality. Political commitment (documentation of the cervical cancer screening policy as law) and financial support (treatment services provided free of charge) positively associated with screening coverage.
Screening programmes need strengthening commensurate with local resources and context. Priority should be given to improving screening coverage through stronger political commitment and financial support in low-development countries, and to ensuring good performance at all levels in high-development countries.
宫颈癌是全球健康威胁和不平等的表现，筛查是一种有效的干预措施。然而，对于筛查覆盖率和质量保证如何影响宫颈癌死亡率，我们知之甚少。我们旨在调查不同发展水平国家的妇女的筛查覆盖率、筛查质量保证与宫颈癌死亡率之间的关系。
我们从 GLOBOCAN 2020 数据库中获得了宫颈癌年龄标准化死亡率的数据；从世界卫生组织（WHO）全球卫生观测站获得了宫颈癌筛查覆盖率的数据；从癌症在五大洲筛查（CanScreen5）数据库获得了宫颈癌筛查计划设置和质量保证的数据。我们通过简单和多元回归模型评估了宫颈癌年龄标准化死亡率与筛查覆盖率和质量保证的依赖关系。我们还使用线性回归模型来确定哪些因素可以提高筛查覆盖率。
本研究纳入了来自 53 个国家的数据。在 22 个高发展中国家，筛查计划质量保证的提高与死亡率的降低有关。在 31 个低发展中国家，30-49 岁妇女的筛查覆盖率与宫颈癌死亡率呈负相关。政治承诺（将宫颈癌筛查政策作为法律加以规定）和财政支持（免费提供治疗服务）与筛查覆盖率呈正相关。
筛查计划需要根据当地资源和情况进行加强。在低发展中国家，应优先通过更强有力的政治承诺和财政支持来提高筛查覆盖率，在高发展中国家则应优先确保各级的良好表现。
