Recent Developments in the Dutch Cervical Cancer Screening Programme

Worldwide, cervical cancer is the second most common female malignancy, diagnosed in 500,000 women each year, while 275,000 die from it. Without prevention, the peak incidence occurs at a relatively young age, between 40-55 years, when women are still active on the labour market and have young children. While cervical cancer is the leading cancer-related cause of death and the second most common cancer in women in developing countries (incidence rates ≥30 per 100,000), it became much less common in developed countries in the recent decades. In the Netherlands, the incidence and mortality have been decreasing for decades (Figure 1-1). In 2003, cervical cancer was newly diagnosed in 584 women (World standardized incidence rate (WSR): 4.9 per 100,000 women) and 214 women died from it (WSR: 1.4 per 100,000 women). Inter-country differences in cervical cancer incidence are caused by differences in determinants and in access to preventive measures. The prevalence of the Human Papillomavirus (HPV) infection, the necessary factor in the development of cervical cancer, is generally higher in developing countries. Differences in the host factor, e.g. more common malnourishment and the prevalence of other infections in the developing countries, may also play a role. These countries typically do not offer population-wide cervical cancer screening facilities, which require a high level of organization and adequate health care resources

COVID-19 disruption to cervical cancer screening in England

INTRODUCTION: In England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC). METHODS: Using Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25–64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age). RESULTS: The number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round. CONCLUSION: Prompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend

Long-term excess risk of breast cancer after a single breast density measurement.

AIM: Breast density is a risk factor for breast cancer. As density changes across a woman's life span, we studied for how long a single density measurement taken in (post-)menopausal women remains informative. METHODS: We used data from Singaporean women who underwent a single mammography screen at age 50-64 years. For each case with breast cancer diagnosed at screening or in the subsequent 10 years, whether screen detected or diagnosed following symptoms, two age-matched controls were selected. We studied the excess risk of breast cancer, calculated as an odds ratio (OR) with conditional logistic regression and adjusted for body mass index, associated with 26-50% and with 51-100% density compared with ≤25% density by time since screening. RESULTS: In total, 490 women had breast cancer, of which 361 were diagnosed because of symptoms after screening. Women with 51-100% breast density had an excess risk of breast cancer that did not seem to attenuate with time. In 1-3 years after screening, the OR was 2.22 (95% confidence interval [CI]: 1.07-4.61); in 4-6 years after screening, the OR was 4.09 (95% CI: 2.21-7.58), and in 7-10 years after screening, the OR was 5.35 (95% CI: 2.57-11.15). Excess risk with a stable OR of about 2 was also observed for women with 26-50% breast density. These patterns were robust when the analyses were limited to post-menopausal women, non-users of hormonal replacement therapy and after stratification by age at density measurement. CONCLUSION: A single breast density measurement identifies women with an excess risk of breast cancer during at least the subsequent 10 years.Cancer Research UK (grant number: C8162/A16892)Singapore National Medical Research CouncilDepartment of Health Policy Research Programme (106/0001

Maximising Social Interactions and Effectiveness within Distance Learning Courses: Cases from Construction

Advanced Internet technologies have revolutionised the delivery of distance learning education. As a result, the physical proximity between learners and the learning providers has become less important. However, whilst the pervasiveness of these technological developments has reached unprecedented levels, critics argue that the student learning experience is still not as effective as conventional face-to-face delivery. In this regard, surveys of distance learning courses reveal that there is often a lack of social interaction attributed to this method of delivery, which tends to leave learners feeling isolated due to a lack of engagement, direction, guidance and support by the tutor. This paper defines and conceptualises this phenomenon by investigating the extent to which distance-learning programmes provide the social interactions of an equivalent traditional classroom setting. In this respect, two distance learning case studies were investigated, covering the UK and Slovenian markets respectively. Research findings identified that delivery success is strongly dependent on the particular context to which the specific distance learning course is designed, structured and augmented. It is therefore recommended that designers of distance learning courses should balance the tensions and nuances associated with commercial viability and pedagogic effectiveness

Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: Population based cohort study

Abstract Objective To compare the risk of cervical cancer in women with histologically confirmed cervical intraepithelial neoplasia who returned to routine screening after having completed post-treatment follow-up with consecutive normal smear test results with women with a normal primary smear test result. Design Population based cohort study using data from a nationwide pathology register. Setting The Netherlands, 1994 to 2006. Population 38 956 women with histologically confirmed intraepithelial neoplasia grades 1 to 3 with completed follow-up after treatment. Intervention Routine post-treatment follow-up of cervical intraepithelial neoplasia, recommending smear tests at six, 12, and 24 months. Main outcome measure Incidence of cervical cancer in the period from completed follow-up with negative test results after cervical intraepithelial neoplasia to the next primary test. 10-year hazard ratios were compared with periods after normal results for the primary smear test, adjusted for year in follow-up. Results 20 cervical cancers were diagnosed during 56 956 woman years after completed follow-up of cervical intraepithelial neoplasia, whereas 1613 cervical cancers were diagnosed during 25 020 697 woman years after a normal primary smear test result. The incidence of 35.1 (95% confidence interval 21.4 to 54.2) per 100 000 woman years and 6.4 (6.1 to 6.8) per 100 000 woman years, respectively, led to an adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for periods after completed follow-up compared with periods after normal primary smear test results. This hazard ratio was increased for all ages. No significant difference in risk of cervical cancer was observed by grade of cervical intraepithelial neoplasia. Conclusions An excess risk

Cytology interpretation after a change to HPV testing in primary cervical screening : observational study from the English pilot

Background Overcalling of abnormalities has been a concern for using cytology triage after positive high-risk human papillomavirus (HPV) tests in cervical screening. Methods The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests. Results Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj], 1.16; 95% confidence interval [CI], 1.14-1.18). Laboratories with higher direct referral referred fewer persistently HPV-positive women after early recall. The detection of high-grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13-1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high-grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj, 2.05; 95% CI, 1.43-2.93). Conclusions Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology