Ingrid Baasland

Communicating abnormal cervical cancer screening results – a focus group study with general practitioners in Norway

A gradual transition from cytology-based screening to Human Papillomavirus (HPV) testing within the cervical cancer screening program has resulted in new routines for follow-up, and new challenges for communication of abnormal test results. General practitioners (GPs) have an important role in the screening program, as they are the primary performers of the screening test, they communicate test results to patients and refer them to a specialist if necessary. The study explores what consequences the introduction of HPV testing in the cervical cancer screening programme has for GPs' professional practice and communication with patients. Qualitative focus group study including 32 GPs in Central Norway who conduct screening tests within the cervical cancer screening programme. The overall concern of the GPs was to communicate abnormal test results in a way that ensured appropriate follow-up, without causing unnecessary worry. Staying updated on revised screening guidelines and maintaining their role as medical experts when communicating results to patients could be challenging. GPs shared the responsibility for follow-up after an abnormal result between themselves, the women, and the screening programme. Reciprocal familiarity between GP and patient guided decisions about what and how to communicate, and how to balance the shared responsibility. GPs used their professional judgement to assess patients' informational needs and tailored information accordingly. GPs manage the challenges of communicating abnormal screening results by sharing responsibility and using their professional judgement. Strengthening support and communication tools may enhance their role in the screening programme.

Cervical intraepithelial neoplasia grade 1 and long-term risk of progression and treatment

Background Cervical intraepithelial neoplasia grade 1 (CIN1) is often managed by active surveillance, as the risk of progression to high grade lesions is reported to be low, but long-term data is sparse. To inform management of CIN1, we estimated risk of progression and occurrence of treatment in women attending a cervical cancer screening program. Methods We used nationwide, registry data on all women aged 25–69 years attending the Norwegian Cervical Cancer Screening Program in 2002–2019. The eligible source population was women with at least one cytology registration (n = 1,771,876). Women with a histologically confirmed, first CIN1 diagnosis were included (n = 26,130) and followed for detection of CIN2+, defined as histologically confirmed CIN2, CIN3, adenocarcinoma in situ (AIS), or cervical cancer. CIN3+ was defined as CIN3, AIS, or cervical cancer. Treatment included both excision and ablation. Results Overall, the cumulative incidence of CIN2+ increased to 9.5% (95% confidence interval (CI), 8.8 to 9.5) during the first year and to 19.0% (95% CI, 18.4–19.5) during the first five years. For women with high-grade cytology, 5-year cumulative incidence reached 26.0% (95% CI, 25.0–27.0), whereas for women with normal or low-grade cytology, but HPV16 and/or HPV18 positive status, the corresponding estimate was 25.0% (95% CI, 23.3–26.8). Other high-risk HPV genotypes and HPV negative status were associated with lower risks (5-year cumulative incidence 15.5% (95% CI, 14.5–16.6) and 8.2% (95% CI, 7.1–9.5), respectively). Detection of CIN3+ was substantial (cumulative incidence 5.7% (95% CI, 5.4–6.0) and 12.7% (95% CI, 12.2–13.1) after 1 and 5 years, respectively), and overall, cumulative incidence of treatment was 15.2% (95% CI, 14.7–15.7) after 5 years, following similar patterns as observed for CIN2+. Conclusions A differentiation of follow-up guidelines by index cytology and HPV16/18 status for women diagnosed with CIN1, might be warranted.

Cervical cancer mortality in Norway according to screening attendance and age

AbstractIntroductionThe association between cervical cancer screening and reduction of cervical cancer has been dealt with in much research. However, little has been published on the association between screening and cervical cancer mortality. We assessed cervical cancer deaths according to screening history, histopathology, and age among women in, under, and above screening age.Material and methodsIn this nationwide, registry‐based case–control study from Norway, we included 817 cervical cancer deaths in women diagnosed with cervical cancer in the period 1998–2009. We matched each case with 10 population‐based controls free from cervical cancer, obtained by density‐based sampling. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between screening attendance and cervical cancer mortality were estimated using conditional logistic regression models.ResultsOf all fatal cervical cancers, 35% were diagnosed among women over screening age and altogether, 83% were either in age groups not covered by the screening program or in non‐attenders of screening age. The estimated risk reduction associated with a cytology test in the preceding 3.5 years was 80% in screening age 25–69 years (OR 0.20; 95% CI 0.16–0.24) with the largest reduction in squamous cell carcinomas (84%) but also a substantial estimated risk reduction of 65% for adenocarcinomas. The associated risk reduction was strongest in women aged 45–69 years, with ORs in the range 0.09–0.18, compared with ORs 0.42–1.35 in women aged 25–39 years.ConclusionsTo reduce the mortality of cervical cancer, screening programs should focus on increasing adherence to the program, as half of all the fatal cases were in the non‐attender group. Further assessments regarding the potential preventive impact of extending screening to women over the current screening age should be considered.