Gaps between recommendations and their implementation: A register-based study of follow-up after abnormalities in cervical cancer screening

TY - JOUR

T1 - Gaps between recommendations and their implementation

T2 - A register-based study of follow-up after abnormalities in cervical cancer screening

AU - Jørgensen, Susanne Fogh

AU - Andersen, Berit

AU - Rebolj, Matejka

AU - Njor, Sisse Helle

N1 - Funding Information: Susanne Fogh Jørgensen reports no conflict of interest. Berit Andersen received HPV tests from Roche and self-sampling kits for HPV self-sampling for other studies. The department received a grant from Helsefonden during this study. Matejka Rebolj's employer received a speaker fee on her behalf from Hologic. She has attended meetings with manufacturers of various screening technologies. Sisse Helle Njor reports a grant from Helsefonden during this study. Funding Information: This study was funded by Helsefonden (grant number: 16-B-0171 ). MR was funded by Cancer Research UK (grant number: C8162/A27047 ). None of the funders were involved in the development of the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: © 2021 Elsevier Inc. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/5

Y1 - 2021/5

N2 - Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23–59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. We studied the timeliness and appropriateness of follow-up tests after cervical cytology screening and the total resource use in accordance with the national recommendations. Regression analyses were used to determine variations in adherence according to age, provider type, region, and history of abnormalities. Among women referred for immediate colposcopy, 91.3% (95% CI: 90.9%–91.6%) attended within four months as recommended, whereas up to about half of the women with a recommendation for a repeat test received this test either too early or very late. Overall, only 43% (95% CI: 42.9%–43.7%) of women with non-negative screening tests received the recommended follow-up, whereas 18% (95% CI: 17.6%–18.2%) received more than was recommended, 35% (95% CI: 34.4%–35.1%) received some follow-up but less than recommended and 4% (95% CI: 3.9%–4.2%) were not followed up at all. These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.

AB - Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23–59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. We studied the timeliness and appropriateness of follow-up tests after cervical cytology screening and the total resource use in accordance with the national recommendations. Regression analyses were used to determine variations in adherence according to age, provider type, region, and history of abnormalities. Among women referred for immediate colposcopy, 91.3% (95% CI: 90.9%–91.6%) attended within four months as recommended, whereas up to about half of the women with a recommendation for a repeat test received this test either too early or very late. Overall, only 43% (95% CI: 42.9%–43.7%) of women with non-negative screening tests received the recommended follow-up, whereas 18% (95% CI: 17.6%–18.2%) received more than was recommended, 35% (95% CI: 34.4%–35.1%) received some follow-up but less than recommended and 4% (95% CI: 3.9%–4.2%) were not followed up at all. These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.

KW - Cervical Intraepithelial Neoplasia

KW - Colposcopy

KW - Early Detection of Cancer

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Mass Screening

KW - Papillomavirus Infections

KW - Pregnancy

KW - Uterine Cervical Neoplasms/diagnosis

KW - Vaginal Smears

UR - http://www.scopus.com/inward/record.url?scp=85101851568&partnerID=8YFLogxK

U2 - 10.1016/j.ypmed.2021.106468

DO - 10.1016/j.ypmed.2021.106468

M3 - Article

C2 - 33636193

AN - SCOPUS:85101851568

SN - 0091-7435

VL - 146

JO - Preventive Medicine

JF - Preventive Medicine

M1 - 106468

ER -