[Effectiveness of cervical screening - expectation and reality]

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Cervical cancer screening programs are crucial for early detection and prevention.
• Evaluating the long-term effectiveness of such programs is essential for public health.
• The study focuses on the Bulgarian cervical screening program from 1975 to 1996.

Purpose of the Study:

• To assess the effectiveness of Bulgaria's cervical screening program between 1975 and 1996.
• To analyze trends in invasive cervical cancer versus carcinoma in situ (CIS) ratios.
• To evaluate the proportion of women with abnormal cytology who were diagnosed with cervical cancer.

Main Methods:

• Retrospective analysis of cervical screening data from 1975-1996 in Bulgaria.
• Examination of the ratio of invasive cervical cancer to CIS incidence.
• Analysis of the percentage of cytologically detected cases confirmed by biopsy.

Main Results:

• A deteriorating trend was observed in key screening indices.
• The incidence of crude cervical cancer ranged from 12.7 to 22.7 per 10^5 women.
• The frequency of CIS ranged from 3.2 to 6.2 per 10^5 women, with an unfavorable invasive cancer to CIS ratio (2:1 to over 5:1).
• The rate of cytologically detected cases confirmed by biopsy was low (15.6%-33.3%), with exceptions in specific regions.
• The study highlights the low effectiveness of the implemented cervical screening program.

Conclusions:

• The cervical screening program in Bulgaria during the study period was largely ineffective.
• A significant weakness was the absence of a screening register, impeding lesion management.
• Improvements in registration, follow-up, and therapy are necessary for effective cervical cancer prevention.