Fitzpatrick Patricia, Mooney Therese, Williams Yvonne, Mohan Caroline Mason, Bonde Jesper, Gao Julia, Nowakowski Andrzej, Haelens Annemie, Ivanus Urska, Pankakoski Maiju, Karapetyan Tina, Russell Noirin E
University College Dublin, Dublin, Ireland.
National Screening Service, Dublin, Ireland.
Acta Obstet Gynecol Scand. 2025 Sep;104(9):1705-1711. doi: 10.1111/aogs.15172. Epub 2025 Jun 16.
In 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.
A web-based questionnaire was sent to 18 population-based cervical screening programs. Inclusion criteria involved (1) a national or regional population-based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.
The response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3-5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.
There is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.
2018年，爱尔兰国家宫颈癌筛查项目中，间期癌回顾性细胞学检查结果未公开引发了一场危机。作为回应，召集了一个专家咨询小组，该小组建议采用合作方式制定一项新的关键绩效指标——间期癌发生率。专家咨询小组还建议，爱尔兰项目应与国际同行合作，就以下方面达成共识：（i）间期宫颈癌的定义；（ii）计算间期癌发生率的方法；（iii）与其他国际项目进行基准对比。本研究旨在确定是否存在关于间期宫颈癌定义和间期癌发生率计算的共识。
向18个基于人群的宫颈癌筛查项目发送了一份网络调查问卷。纳入标准包括：（1）国家或地区层面基于人群的宫颈癌筛查项目；（2）人口≥爱尔兰人口的国家或地区；（3）位于欧洲、澳大利亚或加拿大的项目；（4）曾对之前发表的关于宫颈癌病例回顾性细胞学检查结果公开情况的国际调查做出回应的项目。
18个项目中有9个做出了回应。在9名受访者中，6个对间期宫颈癌有一致的定义，其中4个计算了间期癌发生率。3个项目既未计算间期癌发生率，也没有与之相关的任何指南。在有一致定义的6个项目中，所有受访者将分子定义为筛查年龄组中的浸润性癌，其中4个包括微浸润性疾病。受访者纳入了在上次筛查测试后3至5年诊断出的癌症。3名受访者还纳入了在退出筛查项目后长达3.5年的女性中诊断出的癌症。各国使用不同的分母，包括：（i）每妇女年；（ii）每筛查次数；（iii）筛查人群中的总癌症数。
间期癌发生率计算中使用的参数存在差异。为了能够对宫颈癌筛查项目的绩效进行基准对比，需要就间期癌定义和间期癌发生率计算的标准化方法达成共识。
