Cervical Cancer Screening in Tuscany: A Survey of the Actual State of Cervical Cancer Prevention in the Local Sanitary Units of the Tuscan Region

An Attempt to Increase Compliance to Cervical Cancer Screening through General Practitioners

The authors report the results of a campaign aimed at increasing compliance to cervical cancer screening by promoting general practitioners’ (GPs) cooperation. Different types of intervention were tested, namely mailing lists of non responders to the GP, visiting the GP at the office, or both. No active intervention was made in a sample of GPs who served as a control group. Overall 288 GPs assisting 75,853 women aged 25 to 59 were enrolled in the study. Compliance before and after the campaign was studied and the association between compliance and different variables such as age, residence and type of intervention was tested by univariate and multivariate analysis. The proportion of previous non responders who performed a Pap test after the campaign was 6.7 %, the response being dependent on age (25-29 = 11.5 %, 30-39 = 8.8 %, 40-49 = 6.5 %, 50-59 = 4.2 %) and place of residence (urban = 7.2 %, suburban = 5.9 %, rural = 4.0 %). Compliance was better in the case of the active campaign (list mailing = 8.3 %, visit = 7.0 %, list+visit = 7.2 %) with respect to controls (2.9 %) although no significant differences were detected between different types of active intervention. Compliance to cervical cancer screening may be increased by promoting GPs cooperation but the benefit is limited. Mailing lists of non responders was found the most cost effective policy in this study.

Survey of Performance of Cervical Cytopathology Laboratories and of Screening Programs in Italy

Structure, performance, management, quality control and participation in screening programs of cervical cytology laboratories have been evaluated through a questionnaire sent to all public Italian hospitals, relevant university departments and senior members of relevant scientific associations. Completed questionnaires were received from 276 centers, which gives a response rate of 73%. In this report we concentrate on the need for improvement, but there are a number of centers who have all or almost all the features traditionally associated with good or excellent practice. The main results of the survey are the following. Most of the centers examine relatively few cervical smears, so their workload could be considered too low for maintaining a good level of practice. Six centers examine 3 specimens per woman, about 25% examine 2 specimens, and the rest only 1 specimen. There is a marked variability in filing and storing practices of positive and negative smears and results. Internal quality control is inadequate in most centers, and external quality control is limited to voluntary exchange of dubious or interesting smears. Only half of the centers are involved in screening programs. In 75% of the programs the suggested screening interval is 1 year or even 6 months; only 7 (4.5%) agree with the UICC/ IARC recommended interval of 3 years. The target population coverage varies from 10% to 85%, and it is less than 50% in 78% of the programs. Only 6 programs have an active women's call system. The survey has confirmed the need for launching a national program of internal and external quality control. Almost all centers have expressed their interest to take part.

Pattern of Cervical Screening Utilization in Italy

The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22 %), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11 %) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.