Cancer is common in older people but cancer of the uterine cervix primarily affects younger women, with the majority of cases appearing between the ages of 35 and 50, when many women are actively involved in their careers or caring for their families. In the European Union (EU) 34 000 new cases and over 16 000 deaths due to cervical cancer are reported annually (Arbyn et al., 2007a & c).

The burden of cervical cancer is particularly high in the new member states. The highest annual world-standardised mortality rates are currently reported in Romania and Lithuania (13.7 and 10.0/100 000, respectively) and the lowest rates in Finland (1.1/100 000). Governmental authorities, parliamentary representatives and advocates should be aware that the substantially higher dimension of this public health problem in the east of the EU requires special attention.

Among all malignant tumours, cervical cancer is the one that can be most effectively controlled by screening. Detection of cytological abnormalities by microscopic examination of Pap smears, and subsequent treatment of women with high-grade cytological abnormalities avoids development of cancer (Miller, 1993).

Cytological screening at the population level every three to five years can reduce cervical cander incidence up to 80% (IARC, 2005). Such benefits can only be achieved if quality is optimal at every step in the screening process, from information and invitation of the eligible target population, to performance of the screening test and follow-up, and, if necessary, treatment of women with screen-detected abnormalities.

Population-based screening policy and organisation conforming to evidence-based standards and procedures provide the overall programmatic framework essential to implementation of quality assurance and are therefore crucial to the success of any cervical cancer screening programme.

Establishment of screening registries and linkage of individual screening data with cancer registry data, taking into account appropriate data protection standards and methods, are essential tools of monitoring and evaluation.

The first edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening (Coleman et al., 1993) established the principles of organised, population-based screening and was pivotal in initiating pilot projects in Europe. A number of countries have in the meantime developed organised, population-based screening approaches, which are illustrated in the second edition.

It is hoped that this new guideline edition will have a greater impact on those countries in which opportunistic, rather than organised, population-based screening has been the preferred model in the past. Toward this end, considerable attention has been given to the essential aspects of developing an organised, population-based programme policy that minimises the adverse effects and maximises the benefits of screening.

The current recommendations are also particularly relevant to planning new cervical cancer screening programmes in Europe. Different solutions fulfilling the recommended methodological standards need to be implemented in different countries and regions with diverse levels of resources and general healthcare infrastructure.

More than a decade has passed since publication of the first guideline edition. The current, expanded edition therefore also includes extensive updates on technical details and documentation, as well as assessment of new technologies, e.g.: liquid-based cytology, automated interpretation of Pap smears and testing for human papillomaviruses. The scope of the current guideline has also been extended to include comprehensive instructions prepared by a multi-disciplinary team of experts for general practitioners, gynaecologists and cytopathologists. Much more extensive recommendations on follow-up, diagnosis and management of women with positive cervical cytology have been added.

This necessitated the incorporation in the second edition of a separate chapter on techniques and quality assurance in histopathology and, for the first time, detailed guidance for clinicians in dealing with abnormal cytology, including management according to the severity of cytological abnormalities and management of histologically confirmed cervical epithelial neoplasia.

A major further addition has been the inclusion of uniform indicators for monitoring programme performance and for identifying and reacting to potential problems at an early time. The indicators deal with screening intensity, test performance, and diagnostic assessment and treatment, and address aspects of the screening process that influence the impact, as well as the human and financial costs of screening. Standard tables have been provided for documenting screening policies, and for tabulating the person-based data used to generate the uniform performance indicators.

The availability of these standardised tools will substantially improve data comparability and the exchange of experience and results between screening programmes in Europe. Such exchange, in turn, is esential to effective pan-European collaboration in implementing and continuously improving the quality and effectiveness of cervical cancer screening programmes.

Cervical cytology still is the cornerstone of cervical cancer prevention programmes in Europe, although new perspectives for other screening technologies are developing rapidly. The principles of quality assurance, performance monitoring and evaluation, and many of the procedures and methodological standards laid down in the current guideline edition are of equal relevance to cervical cancer screening based on other conceivable methods.

It is therefore expected that the publication of the updated and revised second edition will also promote rigorous standards in the evaluation and application of new screening technologies, thereby improving the effectiveness of cervical cancer prevention in Europe. ... (Executiive Summary)

Download European Guidelines for Quality Assurance in Cervical Cancer Screening (Second Edition)

PDF format, 8.8MB, 324Pages, provided by europa.eu.

More information on the European Union is available on the Internet (http://europa.eu).
Cataloguing data can be found at the end of this publication.
Luxembourg: Office for Official Publications of the European Communities, 2008
ISBN 978-92-79-07698-5
© European Communities, 2008

EDITORS:

Marc Arbyn
Unit of Cancer Epidemiology, Department of Epidemiology
Scientific Institute of Public Health
Brussels, Belgium

Ahti Anttila
Mass Screening Registry, Finnish Cancer Registry
Helsinki, Finland

Joe Jordan
Birmingham Women’s Hospital
Birmingham, United Kingdom

Guglielmo Ronco
Unit of Cancer Epidemiology
Centre for Cancer Epidemiology and Prevention (CPO Piemonte)
Turin, Italy

Ulrich Schenck
Institute of Pathology, Technical University
Munich, Germany

Nereo Segnan
Unit of cancer Epidemiology, Department of Oncology
CPO Piemonte (Piedmont Centre for Cancer Prevention) and S. Giovanni Hospital
Turin, Italy

Helene G. Wiener
Clinical Institute of Pathology, Medical University of Vienna
Vienna, Austria

Amanda Herbert
Guy’s & St Thomas’ NHS Foundation Trust
London, United Kingdom

John Daniel
International Agency for Research on Cancer
Lyon, France

Lawrence von Karsa
European Cancer Network (ECN) Coordination Office
Screening Quality Control Group
International Agency for Research on Cancer
Lyon, France

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