ORGANISATIONAL ASPECTS OF SUCCESSFUL SCREENING PROGRAMMES IN DEVELOPED COUNTRIES: THE ENGLISH MODEL.

Assessing benefits, risks, and costs of cancer screening In planning a cancer screening programme, each country will develop guidelines based on the best available estimates of costs, benefits, and risks. Guidelines can be reviewed in light of emerging evidence as well as new diagnostic and treatment options. Evaluation of a programme's coverage should consider the age of eligible participants, the frequency of testing, and community awareness of, and access to, the programme. All will impact on cost and effectiveness. Recommendations on the age of initiation and frequency of cervical screening vary between European countries. Van Ballegooijen et al compared the relative cost-effectiveness of programmes in European countries based on recommended screening age ranges and intervals and coverage (Table 2) [39]. Sasieni et al used UK data to compare the incidence of cervical cancer in different age groups of women against the number of years since their last negative screening result [40]. His findings revealed that less frequent screening may confer greater advantages in older women (> 40 years) compared with younger women. He found that 5-yearly screening offers considerable protection (83%) against cancer at ages 55-69 years; annual screening provides only modest additional protection (87%). On this basis the cervical screening programme now offers 3-yearly and 5-yearly screening for women aged 25-50 and 50-64 years, respectively. The proportion of women in the community who are screened at the recommended frequency will also influence any evaluation. In 2004, around four in every five British women aged 25-64 years had been screened for cervical cancer within the previous 5 years. Primary care practices carry the prime responsibility for the continuity of testing. A review of primary care organisations in 2004 showed that coverage of eligible women in different practices varied from 70% to 90%. Training and evaluation programmes in cytology and colposcopy have been established. The majority of British laboratories reviewed in 2003-2004 achieved 65-85% positive predictive values in their reviews of cervical smears (the proportion of high-grade cytology associated with underlying high grade CIN). National computerised colposcopy data is not routinely collected; for example in 2003-2004, more than 70% of women with abnormal screening results saw a specialist for colposcopy within 8 weeks. This was followed by a diagnostic biopsy in 40% of cases, and 19% had lesions excised on that first visit. In 37% of referred patients, colposcopy appeared normal and no procedure was required. New options such as HPV DNA testing, the availability of liquid-based cytology and a growing awareness of the relatively small benefits gained through frequent testing for women < 40 years of age, are likely to influence the evolution of the British screening programme. [ABSTRACT FROM AUTHOR]