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Quality of screening with conventional Pap smear in Austria - a longitudinal evaluation.

ABSTRACT: BACKGROUND: In recent decades, the incidence of cervical cancer and cervical cancer mortality in Austria has declined by varying degrees. The Pap smear is to be considered a causal factor for this decline. METHODS: This longitudinal analysis is based on a data set of Pap smear assessments collected by the Committee for Quality Assurance of the Austrian Society of Cytology. Data from 15 laboratories participating in a voluntary self-monitoring program was analyzed for the time span 2004-2008. The data was analyzed in terms of smear quality and assessment quality.A rank-correlation-test for a monotonic trend analysis in the proportion of the three parameters Pap 0, "satisfactory, but limited/SBL", and Pap IIID/IV for the timespan 2004 to 2008 was carried out. RESULTS: For this study, we analyzed an average number of 730,000 smears per year over a five-year period. Specimens from all but two laboratories, i.e. < 2% of all smears, met the quality criterion for Pap 0 (Bethesda 2001 equivalent: Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality), whilst only four laboratories, i.e. < 10% of all smears, reached the national requirement for smears classified as "satisfactory, but limited/SBL".When using the Pap IIID/IV ratio (LSIL: HSIL/AIS ratio) of 3:1 to 8:1 as a surrogate quality marker for the interpretation of smears, only five laboratories met this criterion during the survey period.The trend analysis indicated only that an increasing number of samples per year is correlated with an increased proportion of Pap 0 and "satisfactory, but limited/SBL" smears. CONCLUSIONS: Although participants get regular feedback about their results, no general improvements in smear taking or assessment were observed over the years, so mandatory quality management, including the possibility of sanctions, is suggested in order to reduce adverse health effects for women.

SUBMITTER: Rasky E

PROVIDER: S-EPMC4015555 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Quality of screening with conventional Pap smear in Austria - a longitudinal evaluation.

Rásky Éva É Regitnig Peter P Schenouda Michél M Burkert Nathalie N Freidl Wolfgang W

BMC public health 20131023

<h4>Background</h4>In recent decades, the incidence of cervical cancer and cervical cancer mortality in Austria has declined by varying degrees. The Pap smear is to be considered a causal factor for this decline.<h4>Methods</h4>This longitudinal analysis is based on a data set of Pap smear assessments collected by the Committee for Quality Assurance of the Austrian Society of Cytology. Data from 15 laboratories participating in a voluntary self-monitoring program was analyzed for the time span 2 ...[more]

PMID: 24152300

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Project description:BackgroundCervical cancer is a major global public health concern, with 85% of cases occurring in low- and middle-income countries. In South Africa, it is the second most common cancer amongst women. Screening and treatment of cervical cancer precursor lesions is associated with a lower incidence and mortality. This research determines the associations between women's beliefs about cervical cancer and screening and the uptake of Papanicolaou (Pap) smears in Johannesburg, where cervical screening uptake is suboptimal.MethodsThis research was approved by the University of Witwatersrand Human Research Ethics Committee (Medical), clearance certificate number: M170243 and the Johannesburg District Heath Research Committee prior to conducting the study. All participants signed a consent form prior to participating in this study. This cross-sectional analytical study used an interviewer-administered validated measurement scale based on the Health Belief Model (HBM) to describe health beliefs regarding cervical cancer and screening among 280 women aged 30 years and older, attending Johannesburg primary care facilities in 2017. Logistic regression models, with robust estimation of variance to account for clustering of women within clinics, were fitted to identify health beliefs (perceived susceptibility, severity, barriers and benefit, cues to action, and self-efficacy) associated with ever having had a Pap smear (screening uptake), while controlling for knowledge of screening and potential confounders.ResultsOf the 280 women, 177 (63.2%) had ever been screened, 180 (64.3%) were never married, 199 (71.1%) attained secondary education and 133 (47.5%) were employed full time. Women of older age (AOR = 1.6 for a 5-year increase in age; CI: 1.3-1.9; P<0.001), with higher knowledge scores (AOR = 2.5 for a 5-point increase in knowledge score; 95% CI:1.0-6.3;P = 0.051), with lower perceived barriers scores (AOR = 0.4 for a 5-point increase in barriers score; 95% CI:0.3-0.5; P<0.001) and higher perceived severity scores (AOR = 1.3 for a 5-point increase in severity score; 95% CI:1.0-1.6; P = 0.017) were more likely to have had a Pap smear.ConclusionsThis study shows that women who take up screening are older, more knowledgeable regarding cervical cancer and screening, less likely to perceive screening barriers, and more likely to perceive cervical cancer as a severe disease. This highlights that for public health interventions to increase screening uptake, the focus should include tailored behaviour change communication strategies that address women's beliefs regarding screening barriers and emphasize the severity of cervical cancer.

Dataset Information

Quality of screening with conventional Pap smear in Austria - a longitudinal evaluation.

Publications

Quality of screening with conventional Pap smear in Austria - a longitudinal evaluation.

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