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Quality indicators for cervical screening in Sweden
Helena Andersson1,2, Sara Nordqvist Kleppe1,2, Henrik Edvardsson3
1Center for Cervical Cancer Elimination, Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden.
Journal of Medical Screening
|July 31, 2025
Summary
Swedish cervical screening uses 13 quality indicators (QI) to monitor performance. HPV self-sampling maintained high coverage during the pandemic, but follow-up for CIN2+ needs improvement.
Area of Science:
- Public Health
- Gynecologic Oncology
- Epidemiology
Background:
- Quality indicators (QI) are crucial for screening program evaluation but often lack standardization and publication.
- Cervical screening programs rely on QIs for comparisons and optimization, necessitating clear reporting standards.
Purpose of the Study:
- To report 13 established quality indicators (QIs) for cervical screening in Sweden.
- To analyze trends, observations, and the impact of the COVID-19 pandemic on cervical screening QIs.
Main Methods:
- Data collection from the Swedish National Cervical Screening Registry, including invitations, HPV/cytology/histopathology results, population data, and cancer statistics.
- Calculation and analysis of 13 specific QIs for cervical screening.
Main Results:
- High population coverage (83%) for HPV screening, with widespread adoption of self-sampling.
- Follow-up for CIN2+ improved from 60% within 3 months to over 95% within 1 year.
- Decreased incidence and mortality of cervical cancer; some QIs became outdated, and regional variability was noted.
Conclusions:
- HPV self-sampling ensured consistent screening coverage during the pandemic despite appointment cancellations.
- Improving follow-up for screen-positive cases and increasing HPV self-sampling uptake are key areas for enhancement.
