Quality of screening with conventional Pap smear in Austria – a longitudinal evaluation

BMC Public Health

Wolfgang Freidl¹  Nathalie Burkert¹  Michél Schenouda¹  Peter Regitnig²  Éva Rásky¹ 

[1]Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsstrasse 6/I, 8010 Graz, Austria

[2]Austrian Society of Cytology, Auenbruggerplatz 25, 8036 Graz, Austria

关键词: Self-monitoring;    Austria;    Screening;    Pap smear;    Quality assurance;   

Others  :  1161624
DOI  :  10.1186/1471-2458-13-998

 received in 2012-11-30, accepted in 2013-10-14,  发布年份 2013

【 摘 要 】

Background

In recent decades, the incidence of cervical cancer and cervical cancer mortality in Austria has declined by varying degrees. The Pap smear is to be considered a causal factor for this decline.

Methods

This longitudinal analysis is based on a data set of Pap smear assessments collected by the Committee for Quality Assurance of the Austrian Society of Cytology. Data from 15 laboratories participating in a voluntary self-monitoring program was analyzed for the time span 2004–2008. The data was analyzed in terms of smear quality and assessment quality.

A rank-correlation-test for a monotonic trend analysis in the proportion of the three parameters Pap 0, “satisfactory, but limited/SBL”, and Pap IIID/IV for the timespan 2004 to 2008 was carried out.

Results

For this study, we analyzed an average number of 730,000 smears per year over a five-year period. Specimens from all but two laboratories, i.e. < 2% of all smears, met the quality criterion for Pap 0 (Bethesda 2001 equivalent: Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality), whilst only four laboratories, i.e. < 10% of all smears, reached the national requirement for smears classified as “satisfactory, but limited/SBL”.

When using the Pap IIID/IV ratio (LSIL: HSIL/AIS ratio) of 3:1 to 8:1 as a surrogate quality marker for the interpretation of smears, only five laboratories met this criterion during the survey period.

The trend analysis indicated only that an increasing number of samples per year is correlated with an increased proportion of Pap 0 and “satisfactory, but limited/SBL” smears.

Conclusions

Although participants get regular feedback about their results, no general improvements in smear taking or assessment were observed over the years, so mandatory quality management, including the possibility of sanctions, is suggested in order to reduce adverse health effects for women.

【 授权许可】

   
2013 Rásky et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Zielonke N: Krebsinzidenz und Krebsmortalität in Österreich. Vienna: Statistics Austria; 2010:65-67.
• [2]Statistics Austria: Krebserkrankungen. Vienna: Statistics Austria; 2012. http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/gebaermutterhals/index.html; accessed 28th October 2013
• [3]Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, Naghavi M: Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 2011, 378:1461-1484.
• [4]BMG / Federal Ministry of Health: Österreichischer Impfplan. Vienna: BMG; 2013. http://bmg.gv.at/cms/home/attachments/3/3/6/CH1100/CMS1327680589121/impfplan2013.pdf; accessed 3th July 2013
• [5]USPSTF / US Preventive Services Task Force: Guide to clinical preventive services. Washington DC: US Department of Health and Human Services; 1996.
• [6]Breitenecker G, Wiener H, Stani J: Cervical cancer screening in Austria. Eur J Cancer 2000, 36:2189-2190.
• [7]Wiener HG, Rásky É, Horvat R: Description of the national situation of cervical cancer – Austria. Eur J Cancer 2009, 45:2686.
• [8]Breitenecker G, Dinges HP, Regitnig P, Wiener H, Vutuc C: Cytopathology in Austria. Cytopathology 2004, 15:113-118.
• [9]European Commission / EC: European guidelines for quality assurance in mammography screening. Luxembourg: EC; 2006.
• [10]European Commission / EC: European guidelines for quality assurance in cervical screening. Luxembourg: EC; 2008.
• [11]European Commission / EC: European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg: EC; 2011.
• [12]European Parliament: Resolution of 10 April 2008 on combating cancer in the enlarged European Union, P6_TA(2008)0121. Brussels: EU; http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P6-TA-2008-0121&format=XML&language=EN; accessed 28th October 2013
• [13]European Commission / EC: Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening. Luxembourg: EC; 2008.
• [14]Breitenecker G, Dinges HP, Regitnig P: Zervixzytologische Nomenklatur und Befundwiedergabe – Neue Leitlinie der Österreichischen Gesellschaft für Zytologie. Gyn-aktiv 2006, 4:36-37. http://www.cytology.at/pdf/Leitlinien_Nomenklatur.pdf; accessed 16th Oct 2013
• [15]Regitnig P, Breitenecker G, Dinges HP, et al.: Leitlinie zur Qualität in der gynäkologischen Zytologie. ARGE Qualitätssicherung der Österreichischen Gesellschaft für Zytologie und Österreichische Gesellschaft für Pathologie. 2013. http://www.cytology.at/pdf/20130401_OEGZ_OEGP_Leitlinie_zur_Qualitaet_in_der_gynaekologischen_Zytologie_2013.pdf; accessed 3th July 2013
• [16]Dinges HP, Regitnig P, Ropp E, Fladerer H, Moinfar F, Breitenecker G: Früherkennung des Zervixkarzinoms: das Kärntner Qualitätssicherungsprogramm Ergebnisse der Nachkontrolle gynäkologisch-zytologischer Abstriche von Patientinnen mit invasiven Zervixkarzinomen. Frauenarzt 2006, 47:724-729.
• [17]Rásky É: Report “Qualitätsoffensive PAP-Abstrich”, by contract for the Association of Social Insurance Providers. Vienna: HSV; 2007.
• [18]Regitnig P, Dinges HP, Ropp E, Fladerer H, Moinfar F, Breitenecker G: Reevaluation of cytological smears in patients with cervical cancer. Regional quality assurance program with the cooperation of the Austrian Society of Cytology, the Carinthian Medical Association and the Carinthian Ministry of Health. Pathologe 2007, 28(5):339-345.
• [19]Regitnig P, Wilfing C: WGKK Projekt zur PAP-Abstrich-Optimierung. Vienna: WGKK; 2008.
• [20]Regitnig P, Nader A, Wiener H: Quality of conventional Pap smears. Quality assessment and motivation for improvement. Pathologe 2012, 33(4):293-300.
• [21]ÖGZ / Österreichische Gesellschaft für Zytologie: Jahresbericht. 2010.
• [22]Reiner-Concin A: Der PAP-Abstrich. Österreichische Ärztezeitung 2011, 7:26-38.
• [23]Petry KU, Breugelmann JG, Bénard S, Lamure E, Littlewood KJ, Hillemanns P: Cost of screening and treatment of cervical dyscaryosis in Germany. Eur J Gynaecol Oncol 2008, 29(4):345-349.
• [24]Siebert U, Sroczynski G, Hillemanns P, Engel J, Stabenow R, Stegmaier C, Voigt K, Gibis B, Hölzel D, Goldie SJ: The German Cervical Cancer Screening Model: development and validation of a decision-analytic model for cervical cancer screening in Germany. Eur J Public Health 2006, 16(2):185-92.
• [25]Sroczynski G, Schnell-Inderst P, Mühlberger N, Lang K, Aidelsburger P, Wasem J, Mittendorf T, Engel J, Hillemanns P, Petry KU, Krämer A, Sibert U: Cost-effectiveness of primary HPV screening for cervical cancer in Germany – a desicion analysis. Eur J Cancer 2011, 47:1633-1646.
• [26]Mühlhauser I, Filz M: Screening auf Zervixkarzinom. arznei-telegramm 2008, 3:1-38.
• [27]Bortz J, Lienert GA, Böhnke K: Verteilungsfreie Methoden in der Biostatistik. Berlin, Heidelberg: Springer Verlag; 1990.
• [28]Hedges LV, Vevea JL: Fixed- and random-effects models in meta-analysis. Psychol Methods 1998, 3:486-504.
• [29]Statistics Austria: Bevölkerung nach Geschlecht. Vienna: Statistics Austria; 2013. http://www.statistik.at/web_de/statistiken/bevoelkerung/bevoelkerungsstruktur/bevoelkerung_nach_alter_geschlecht/index.html; accessed 3th July 2013
• [30]Wilkinson EJ: Pap smears and screening for cervical neoplasia. Clin Obstet Gynecol 1990, 33:817-825.
• [31]Stenkvist B, Soderstrom J: Reasons for cervical cancer despite extensive screening. J Med Screen 1996, 3:204-207.
• [32]McCrory D, Matchar D, Bastian L, Datta S, Hasselblad V, Hickey J, Myers E, Nanda K: Evaluation of cervical cytology. Evid Rep Technol Assess (Summ) 1999, 5:1-6.
• [33]Canfell K, Barnabas R, Patnick J, Beral V: The predicted effect of changes in cervical screening practice in the UK: results from a modeling study. Br J Cancer 2004, 91(3):530-536.
• [34]Creighton P, Lew JB, Clements M, Smith M, Howard K, Dyer S, Lord S, Canfell K: Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health 2010, 10:734. doi:10.1186/1471-2458-10-734 BioMed Central Full Text
• [35]Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J: Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. Vaccine 2006, 24(Suppl 3):78-89.