SPEACx: a screening pathway-based evaluation and audit framework of cervical cancer diagnostic routes in a...

Cervical cancer audits are widely used to evaluate organized screening programmes, yet existing approaches often fail to clearly attribute cancer diagnoses to specific stages of the screening pathway. This limits the ability to translate audit findings into actionable public health improvements. We developed the Screening Pathway-based Evaluation and Audit of Cervical Cancer (SPEACx) framework to attribute cervical cancer diagnoses across the screening pathway and improve programme evaluation.

The SPEACx framework was developed through an iterative expert consensus process involving screening programme coordinators, gynecologists, and epidemiologists. Cancer cases are attributed to operational stages of screening, including invitation, participation, test performance, follow-up, and post-treatment surveillance. As an applied example, all cervical cancer cases diagnosed within the population-based screening programme of the Basque Country (Spain) between 2018 and 2024 were analysed. Diagnostic pathways and FIGO stage were determined through clinical record review, and stage distributions were compared across major diagnostic pathways.

Among 678 confirmed cervical cancer cases, 34.8% were diagnosed through the screening programme in asymptomatic women, 6.1% were interval cancers, and 55.9% were diagnosed outside the organized programme. Programme-detected cancers were predominantly diagnosed at early stages, whereas interval cancers and cancers diagnosed outside the programme showed substantially higher proportions of advanced disease. Aggregation of SPEACx categories into operational domains enabled identification of key system vulnerabilities related to participation gaps, eligibility criteria, test performance, and follow-up pathways, supporting the development of targeted quality improvement interventions.

SPEACx provides a structured and adaptable framework for attributing cervical cancer diagnoses to specific stages of screening delivery. By enabling attribution of cancer diagnoses to screening processes, SPEACx supports targeted quality improvement and provides a practical tool for public health evaluation of organized cervical cancer screening programmes.

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