A comparison of diagnostic indicators of cervical cancer screening among women accessing through volunteer organisations and those via the organised programme in Turin (Piedmont Region, Northern Italy).

OBJECTIVES: to compare cervical cancer screening diagnostic indicators in women accessing screening through volunteer non-governmental organisations (NGOs) and in those who access via the National Health Service (NHS) programme. DESIGN: cohort study on archive data. SETTING AND PARTICIPANTS: the study cohort consists of 93,086 women aged 30-64 years who underwent an HPV test via NHS screening programme or through premises implemented within volunteers NGOs in Turin between 2015 and 2019. The screening history and Census data recorded into the Piedmont screening archive were used. MAIN OUTCOME MEASURES: positive baseline HPV test, positive triage cytology (low-grade lesions, ASC-US, L-SIL and high-grade lesions, H-SIL, ASC-H, AGC, Cancer), attendance at one-year HPV test repeat, referral and attendance to colposcopy at first and test repeat, and detection rate at first and test repeat, for cervical intraepithelial neoplasia grade >=2 (CIN2+) and >=3 (CIN3+), overall detection rates. RESULTS: women performing cervical screening through volunteer NGOs (WASVO) are disadvantaged in terms of diagnostic indicators compared to women accessing via the NHS. WASVO are 60% more likely to be positive at the first HPV-test (adjusted prevalence ratio 1.6; 95%CI 1.2-2.0); their likelihood of being referred to colposcopy is double (adj PR 2.1; 95%CI 1.3-3.4); attendance rate to one year HPV test repeat is lower (adj PR 0.2; 95%CI 0.1-0.5); detection rates at first HPV screening test both for CIN2+ (adj PR 2.1; 95%CI 0.9-4.6) and CIN3+ (adj PR 2.1; 95%CI 0.9-5.1) is higher, even if statistical significance is borderline for the latter results. CONCLUSIONS: those responsible for screening programmes should establish and maintain collaborative relationships with local volunteer NGOs and migrant organisations for promoting strategies to raise awareness on cancer prevention among subgroups that are not captured in the main screening programs.

[Introduction of a centralised system (Service) for collecting clinical data in cancer screening programmes in Piedmont (Northern Italy): a pre-post assessment of a hub&spoke model]. / L'introduzione di un sistema centralizzato (Service) per la raccolta dei dati clinici negli screening oncologici in Piemonte: valutazione pre-post di un modello hub&spoke.

OBJECTIVES: evaluation of a centralised collection of clinical data (Service) within cancer screening programmes in Piedmont based on a hub&spoke model and its impact on process indicators. DESIGN: assessment of an organisational intervention, through a non-controlled pre-post design. SETTING AND PARTICIPANTS: organised screening programmes within the Piedmont Region, divided into 9 departments. MAIN OUTCOME MEASURES: clinical data (extracted from medical charts for mammography screening and from excision histology reports for cervical screening) obtained through the Service were quantified and their completeness was assessed. The Service impact on the detection rate (DR) was evaluated, comparing the DR pre- (2005-2008) and post-Service (2009- 2012) within breast screening; the DR was computed through histological diagnosis made during colposcopy (pre-Service method) or through the worst diagnosis between the latter and that reported from excision histology (post-Service method) within cervical screening (data available for department 1, year 2013). Some hints on human resources employed in pre- and post-Service periods were reported. RESULTS: within mammography screening, the Service obtained 53.1% of extra-department medical charts and 45.8% of extra-region ones; the percentage of missing diagnoses changed from 5.5% (pre- Service) to 3.7% (post-Service). The age standardised DR for malignant tumours in the post-Service period is 1.3 times the DR of the pre-Service period per 1,000 screening tests. Within cervical screening, 51.7% of histological reports was recorded. Crude DR for high-grade lesions changed from 3.9 (pre-Service) to 4.7 (post-Service) per 1,000 screened women. The system centralisation did not imply an increase in the dedicated personnel. CONCLUSION: the Service is an operational core which coordinates the collection of clinical data, impacting on process indicators without an increase in human resources at departmental level.