Table 1 Adherence of the organised cervical screening programme in Poland to European Guidelines for Quality Assurance in Cervical Cancer Screening [7,8] – screening policy, organisation, monitoring, evaluation and new screening technologies
Point of the guideline | Recommendation of the guidelines | Adherence of the Polish programme to the guideline | |
|---|---|---|---|
Legal regulations, guidelines and protocols | Implementation and clinical practice | ||
Screening type | Population-based public healthcare programme, with identification and personal invitation of each woman in the eligible target population | Partial adherence | |
Full adherence. | Postage of invitations is not regulara. | ||
Screening policy | Selection of screening test systems, determining target age group and interval between normal test results, establishing follow-up and treatment strategies for screen positive women | Partial adherence | |
Treatment strategies are not included in organised screening policy. | Large part of triage of abnormal Pap smears is performed outside the programmeb. | ||
Screening test | Cytology | Full adherence | |
Interval between tests with normal results | 3-5 years | Full adherence | |
Age to start testing | 20-30 years of age | Full adherence | |
Age to stop testing | 60-65 years of age. Stopping screening in older women who have had three or more consecutive recent normal cytology results. | Partial adherence | |
No system of stopping organised screening in older women with previous normal smears has been elaborated. | Opportunistic screening in older women is reimbursed and performed regardless of screening history. | ||
Issue of older women who have never attended screening | Special attention should be paid to older women who have never attended screening as they are at increased risk for CC | Partial adherence | |
No systemic solutions have been undertaken to reach women older than 59 who have never attended screening despite unfavourable epidemiological datac. Women older than 59 are not allowed to undergo organised testing regardless of screening history. | Coordinating Offices and the Ministry of Health undertake multiple actions to increase coverage of the programme and to reach non-attenders among women at the screening age 25-59. | ||
Opportunistic screening | Opportunistic screening should be discouraged. It leads to “overscreening” of selected populations and “underscreening” of groups with less socioeconomic status. | Partial adherence | |
Educational campaigns led by Coordinating Offices have been introduced to discourage opportunistic screening but it is reimbursed and recommended in pregnancy [43]. | Private-based opportunistic screening is popular but its extend and outcomes has never been precisely assessed. There are non-governmental initiatives encouraging opportunistic screening at one year intervals in young age groups [44]. | ||
Information system | Implementation of the information system for managing the screening programme; computing the indicators of attendance, compliance, quality and impact and providing feedback. | Partial adherence | |
The implemented system (SIMP) enables computation of selected indicators from organised screening only. | Only partial data on screening outcomes have been computed and analysed [11-17]. | ||
Linkage between information systems and databases | An appropriate legal framework is required for registration of individual data and linkage between population databases, screening files, cancer and mortality registers. | Partial adherence | |
A screening registry (SIMP) is implemented but not fully integrated with other existing systems and some registries are lackingd. | There is routine input of data into several systems, but they are not integrated. | ||
Publication of programme indicators | Indicators of screening programme extension and quality need to be published regularly. | Partial adherence | |
Data available in SIMP are insufficient to generate some of the crucial indicators for publication. | Only selected indicators of the programme were published regularly by the Central Coordinating Office [11-17]. | ||
New screening technologies | Before routine implementation of new screening technologies phased piloting or even controlled randomised implementation should be executed for its evaluation under real-life conditions. | Partial adherence | |
Randomisation of screening policies is technically feasible. Pilot programme of primary HPV testing is on the way in two regions. | Comprehensive evaluation of pilot HPV testing will be hampered by partial availability of data on the outcomes in SIMP. | ||