Interval cancer audit and disclosure in cervical screening programmes: An international survey

Abstract

Background Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit. Methods A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients. Results Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable. Conclusion The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.

Reasons for truly negative cytology reports preceding the diagnoses of invasive cervical cancer—Results of a false‐negative cytology audit in Polish Cervical Cancer Screening Programme

“…Interval cervical cancer audit should be annually performed in each screening programme, 4 but no coherent methodology has been adapted in this activity worldwide yet. According to the paper by Fitzpatrick et al, distinct audit approaches have been implemented in countries with ongoing CC screening programmes 5 . Differences have been related to various fields: blinding experts to cancer status of women by using additional slides mixed with FNs for re‐evaluation as well as gaining women's consent for participating in audit and informing them on results.…”

“…Correctly identified reasons of FNs may allow for implementation of corrective actions and improvement of screening programme effectiveness. In practice, the audit of FNs is indeed executed in many countries but with heterogeneous methodology 5 …”

“…In practice, the audit of FNs is indeed executed in many countries but with heterogeneous methodology. 5 In Poland, the Cervical Cancer Screening Programme (CCSP) was commenced in late 2006 among insured women between 25 and 59 years old eligible for a cytology once in a 3-year interval. 6 Majority of screening tests has been conventional slides; liquid-based cytologies (LBCs) constituted only a small fraction of them.…”

“…In practice, the audit of FNs is indeed executed in many countries but with heterogeneous methodology. 5 …”

False Negative Results in Cervical Cancer Screening—Risks, Reasons and Implications for Clinical Practice and Public Health

“…“European guidelines of quality assurance in CC screening” recommended auditing all CC cases and their screening history, with special attention paid to those with negative cytology results prior to cancer diagnosis; all FN slides should be seeded among randomly selected screening slides and rescreened [ 20 ]. The audit is, indeed, performed in many countries, with a heterogenous methodology applied [ 41 ].…”