Cervical Cancer Screening Cascade: A Framework for Monitoring Uptake and Retention Along the Screening and Treatment...

Area of Science:

• Public Health
• Gynecologic Oncology
• Epidemiology

Background:

• Cervical cancer remains a significant global health issue, with approximately 350,000 annual deaths.
• The World Health Organization (WHO) has established targets for human papillomavirus (HPV) vaccination, screening, and treatment to facilitate cervical cancer elimination.
• Effective monitoring frameworks are crucial for assessing and optimizing cervical cancer screening program performance, especially with the shift towards HPV primary screening.

Purpose of the Study:

• To introduce a standardized Cervical Cancer Screening Cascade for monitoring HPV-based screening programs.
• To provide a tool for tracking uptake, retention, and outcomes throughout the screening and treatment pathway.
• To identify performance gaps and optimize resource allocation in cervical cancer screening initiatives.

Main Methods:

• Development of a structured cascade through collaboration between public health experts, clinicians, and researchers.
• The Cascade was designed to monitor key performance indicators across four phases: screening, triage, detection, and treatment.
• Each phase includes substages for uptake and results, with an additional 'invitation' substage in the screening phase.

Main Results:

• The Cascade defines specific metrics for each phase: screening (invitation effectiveness, participation), triage (follow-up post-positive screen), detection (diagnostic appointment attendance), and treatment (treatment rate for precancerous lesions).
• It provides a structured approach to evaluate the entire patient journey within HPV-based screening programs.
• The framework facilitates the identification of bottlenecks and areas for improvement in patient management.

Conclusions:

• The Cervical Cancer Screening Cascade offers a valuable tool for both new and existing HPV screening programs, particularly in Canada and similar resource settings.
• It serves as a benchmark for assessing progress towards cervical cancer elimination goals.
• The Cascade aids in optimizing program performance and ensuring timely follow-up and treatment for individuals screened.