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Large performance variation does not affect outcome in the Finnish cervical cancer screening programme.

S Lönnberg¹, P Nieminen, L Kotaniemi-Talonen

¹Finnish Cancer Registry, Helsinki, Finland. stefan.lonnberg@cancer.fi

Cytopathology : Official Journal of the British Society for Clinical Cytology

|January 25, 2011

Summary

Cytology screening for cervical cancer shows significant laboratory performance variations. However, these differences did not impact overall screening effectiveness for detecting cervical intraepithelial neoplasia grade 3 and above (CIN3+).

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Area of Science:

Gynecologic Oncology
Public Health
Laboratory Medicine

Background:

Cytology screening is crucial for cervical cancer prevention, reducing incidence and mortality.
High-quality screening programs require rigorous organization and quality control.
Audit studies are essential for maintaining and improving screening quality.

Purpose of the Study:

To evaluate interlaboratory variations in performance indicators for cervical cytology screening.
To assess the impact of these variations on screening effectiveness, specifically CIN3+ rates after a negative screen.

Main Methods:

Analysis of 953,610 screening tests from seven laboratories (1990-1999).
Linking screening data with cancer registers to identify CIN3+ cases.
Re-evaluation of smears from CIN3+ cases with prior negative screens and controls to determine false negative rates.

Main Results:

Significant interlaboratory variation observed in follow-up recommendations (up to 3.6-fold) and referrals (up to 4.0-fold).
Detection rates for CIN1, CIN2, and CIN3+ varied up to 8.5-fold, 5.4-fold, and 3.3-fold, respectively.
False negative rates showed up to 2.1-fold differences (29-62%), but CIN3+ rates after negative screens remained low and consistent across laboratories.

Conclusions:

Substantial variations exist in laboratory performance indicators and test validity for cervical cytology.
Despite performance heterogeneity, overall screening effectiveness for CIN3+ was not significantly impacted.
Addressing performance variations is important due to potential impacts on cost, treatment, and patient psychological burden.