Surveillance for equity in cervical cytology screening

Area of Science:

• Public Health
• Gynecologic Oncology
• Health Services Research

Background:

• Cervical cancer screening in South Africa is opportunistic, leading to low coverage and rescreening of a small population segment.
• This approach has failed to significantly impact cervical cancer incidence across the broader population.
• High-risk women are often excluded, exacerbating health disparities.

Purpose of the Study:

• To propose and apply a novel indicator for surveillance of equity in cervical cytology screening.
• The indicator is the ratio of cervical intra-epithelial neoplasia (CIN) III to malignancy smears.
• This aims to identify and address inequities in screening programs.

Main Methods:

• Utilized the ratio of CIN III to malignancy smears as a surveillance indicator.
• Applied this indicator to analyze cervical cytology screening data from the Western Cape, South Africa.
• Examined screening patterns across different geographic areas and age groups.

Main Results:

• Demonstrated significant inequities in screening coverage between metropolitan and non-metropolitan areas.
• Identified disparities in screening across different non-metropolitan districts.
• Revealed inequities related to age, with screening activity skewed towards younger women.

Conclusions:

• The proposed CIN III to malignancy ratio is a potentially valuable tool for routine surveillance of cervical screening activity.
• Its application can aid in monitoring progress towards more equitable screening programs.
• Further validation of this indicator in diverse settings is recommended to ensure its generalizability.