Adherence to international recommendations in the governance and organisation of Nordic cervical cancer screening programmes

Abstract

Introduction: Screening has been the primary reason for the decline in the incidence and mortality of cervical cancer in the Nordic countries since the beginning of screening in the 1960s. Recently, the incidence of cervical cancer has increased in the Nordic countries indicating the need to look closely at possibilities for further improvement in screening. This article provides an overview of cervical cancer screening programmes in the Nordic countries and whether the programmes adhere to international recommendations. Materials and methods: Relevant and unambiguous screening recommendations were extracted from applicable literature and classified into legal framework, governance, organisation, and monitoring and evaluation. The up-to-date status of screening programmes and adherence to selected recommendations was gathered from official documentation and co-authors representing cervical cancer screening programmes in all the Nordic countries. Results: A total of 168 recommendations were extracted and 54 of them were considered to be unambiguous and relevant. Forty-nine recommendations were included after synthesising similar recommendations. All Nordic countries adhere to recommendations related to legal framework, but adherence was lower with recommendations related to governance and organisation of screening. Monitoring and evaluation are also areas where adherence to recommendations could be improved. Conclusions: The Nordic cervical cancer screening programmes have substantially decreased cancer burden despite not fully adhering to many of the recommendations. The presented gaps in adherence suggest that there is room for improvement in the screening programmes. Establishing clearer governance structures would still increase the ability to manage changes such as implementing HPV testing as the primary screening method or modifying the programme when HPV vaccinated cohorts of women enter the target age for screening.

Cervical screening during the COVID-19 pandemic: optimising recovery strategies

“…Cervical cancer screening programmes have always differed in various ways. For example, on one hand, Norway, Sweden, Italy, the UK, 12,13 and Australia 14 have introduced population-based screening programmes with organised call-recall systems relying on registries for information on the women's previous screening history. On the other hand, countries such as Japan and Germany do not have national screening registries and instead operate on an opportunistic basis.…”

“…13,15 Some programmes have mainly offered screening through primary care, whereas others have delivered it through specialist services, such as gynaecology. 12,16 Some programmes have started replacing cytology with HPV testing as the primary screening method. This approach has affected the laboratory landscape; for example, HPV testing is completed in an automated way that allows for economies of scale and larger laboratories with smaller workforces.…”

Comparison of cytology and human papillomavirus-based primary testing in cervical screening programs in the Nordic countries

“…The current CC screening programs in the Nordic countries included in this study are summarized in Table 1. Further details on screening programs can be found from a recent article on Nordic CC screening programs, 13 from fact sheets on the NordScreen website (nordscreen.org), and from national documentation. 5,14,15…”

Setting the record straight—Correcting uterine cancer incidence and mortality in the Nordic countries by reallocation of unspecified cases

“…The guidelines also recommend that the percentage of uterine cancer deaths with known topography should be at least 80%. A comparison of Nordic cervical screening programs showed that Nordic countries, except Finland, fail to adhere to this recommendation 5 …”

“…A comparison of Nordic cervical screening programs showed that Nordic countries, except Finland, fail to adhere to this recommendation. 5 Methods exist to correct mortality by reallocating U-NOS to either cervix uteri or corpus uteri. Earlier studies have shown that reallocating U-NOS deaths increases mortality from both cancers.…”