NordScreen – an interactive tool for presenting cervical cancer screening indicators in the Nordic countries

Abstract

Introduction: Quality assurance and improvement of cancer screening programs require up-to-date monitoring systems and evidence-based indicators. National quality reports exist but the definition and calculation of indicators vary making comparisons between countries difficult. The aim is to stimulate collaborative research and quality improvements in screening through freely available, comparable and regularly updated quality indicators. The project currently includes data on cervical cancer screening but population-based screening programs for breast cancer and colorectal cancer may be included in the future. Material and methods: Through a network of Nordic and Baltic screening managers, populationbased individual screening data from each country were converted to standard format in each collaborative center, aggregated by the same R program script and then uploaded to the NordScreen online platform. Registry data included all cervical tests except for Finland where only tests based on invitation are included. Results: The NordScreen collaboration has so far collated standardized indicators based on 32.8 million screening tests from four Nordic countries and Estonia. Interactive comparison of test coverage and distribution of women by number of tests are currently possible online. In 2016, the test coverage within a time interval of 5.5 years in the age group 30-64 year-olds was between 78 and 84% in Iceland, Norway and Sweden whereas 70% in Finland. The application allows users to choose indicator specifications interactively.Conclusions: NordScreen is a pilot model for comparable, reliable and accessible cross-country comparisons of cancer screening. Comparability between countries is enhanced by a uniform data structure and standardized calculations. The comparison of coverage rates to national figures shows that the methods used nationally and in the NordScreen project produce similar results.

Development of Population-Based Cancer Indicators and a Measurement of Cancer Care Continuum Using a Modified Delphi Method

“…Furthermore, we have identified a number of indicators that can be used in a population based on structure, process, and outcome of cancer indicators according to the Donabedian’s model [ 27 ]. Studies have concluded that a comparison of outcomes is challenging at the national and international levels because of the non-parametric nature of the indicators [ 11 , 12 , 20 , 22 , 23 , 24 ]. Our assessment of indicators showed that the structure of cancer care is not a high priority in the healthcare system of Korea, which is already well established.…”

“…To date, development of indicators related to cancer management, have focused one of the following, national cancer screenings or early detection [ 11 , 12 ], diagnosis [ 13 , 14 ], treatment [ 14 ], quality of care [ 15 , 16 , 17 , 18 ], survivor management [ 19 , 20 ], and end-of-life care [ 21 ]. Although there has been much work involved in the development of indicators related to the quality or performance of specific types of cancer [ 16 , 17 , 18 , 19 , 20 , 21 ], minimal attention has been paid to the lifecycle of cancer or cancer care continuum.…”

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

“…Only some of the Nordic countries adhere to the recommendation to include time and place for screening in the invitation. This strategy for increasing coverage should be incorporated to all programmes since none of the countries yet reach the desirable test coverage level of 85% [31] defined in the EU guidelines [8]. Removing the out-of-pocket costs of screening in Iceland and Norway could also help in increasing the coverage.…”

Nordic cervical screening on common ground

“…Nordscreen is a much welcomed initiative to collect and present data on cervical screening activities in the Nordic countries. The database and the interactive webpage are described in this issue of Acta Oncologica [1]. The Nordic countries have much in common in these areas: Tax-funded health-care systems; organized cervical screening since at least two decades; a common commitment to public health with governments' responsibility for the prevention of disease, equally for the entire population; and the personal number system, decisive for effective population-based screening and for monitoring and improving quality by linkage of data.…”