Public Health Research and Practice

Reasons that clinicians in Australia offer cervical screening outside guidelines for frequency, age and co-testing

Objectives and importance of study: Changing cancer screening programs is notoriously difficult and may be influenced by clinicians’ willingness to adhere to new guidelines. Our objective was to investigate clinicians’ adherence to revised cervical screening guidelines and to identify any reasons for testing outside the revised guidelines. Methods: Australian clinicians involved in cervical screening and treating women with cervical abnormalities were invited to complete a cross-sectional online survey between September 2019 and February 2020. We measured self-reported adherence to cervical screening guidelines for three common scenarios and analysed free-text reasons for offering tests contrary to guidelines using content analysis. Results: A total of 607 clinicians (283 general practitioners [GPs], and 324 obstetricians and gynaecologists [O&Gs]) were eligible and participated. Of these, 37.8% of GPs and 43.8% of O&Gs would provide testing more frequently than indicated by guidelines, but recognised the need for patients to be aware of the additional cost and for guidelines to be explained; 13.9% of GPs and 10.2% of O&Gs would screen women at a younger age than indicated due to patient request, patient/family history and the need for patient reassurance; and 11.4% of GPs and 23.6% of O&Gs would perform a HPV and cytology co-test when not indicated, mainly as a result of a mistake or lack of familiarity with guidelines, patient/family history and patient reassurance. Patient request for testing was a reason for testing outside the guidelines with regard to frequency of testing, age of testing and co-testing. Conclusions: These data suggest that it is likely cervical screening outside guidelines is occurring in Australia. As patients often request these tests, strategies to reduce screening outside the guidelines should include ensuring that women are aware of the financial implications and the reasons for the updated guidelines.

How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia

The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to many aspects of life in Australia and globally. This includes actual and potential future impacts on Australia’s three national screening programs for breast, bowel and cervical cancer. These programs aim to improve cancer outcomes through an organised approach to the early detection of cancer and precancer in asymptomatic populations. The design of each program varies according to biological differences in the three cancers, the available screening technology, the target population, and variations in their administration of Australia’s federal, state and territory jurisdictions. The observed and potential impacts of COVID-19 on these programs, and on related activities such as the current national enquiry into lung cancer screening feasibility, therefore vary significantly. This article focuses on observed short-term impacts, adaptations and the longer-term outlook for cancer screening in relation to COVID-19. It summarises potential responses to minimise the harms of disruptions caused by COVID-19, and highlights research and policy opportunities in the pandemic response and recovery which could inform and accelerate optimisation of cancer screening in the long term.

Why would a woman screen? Facilitators and barriers for women least likely to participate in cervical screening in Australia

Renewal of the National Cervical Screening Program: health professionals’ knowledge about screening of specific populations in NSW, Australia

Objectives: The National Cervical Screening Program was renewed in Australia from 1 December 2017, with the introduction of 5-yearly human papilloma virus (HPV) screening from age 25, and the release of updated national screening guidelines. This study aimed to determine health professional knowledge of the renewed screening program following implementation. Methods: We invited health professionals providing cervical screening in New South Wales (NSW), Australia, to complete an online survey in late 2018, to better understand their knowledge of the renewed screening guidelines, in particular regarding screening of specific populations, and to ascertain whether they had undertaken any educational activities relevant to the renewal. Results: A total of 241 responses were included in the data analysis. Health professionals demonstrated good knowledge of some aspects of the renewed program, including 64–85% correctly identifying limited indications for testing people younger than 25 years, 87% correctly identifying the need for completion of the Test of Cure protocol following treatment of high-grade lesions, and 71–80% correctly identifying management of symptomatic women. However several key knowledge gaps were identified including management of immune-deficient women (only 37% of respondents were aware of the need for 3-yearly screening), screening after total hysterectomy (56% were aware of guidance) and approximately 66% of health professionals correctly identifying indications for self-collected screening. One in ten health professionals had not undertaken any education specific to the renewal of the program. We found significant associations between knowledge levels and practitioner characteristics, including practitioners’ frequency of access to the guidelines, specific educational activities undertaken and geographic location. Conclusion: Health professionals demonstrated strong knowledge of key aspects of the renewed National Cervical Screening program. However, our findings highlight some important gaps that may impact successful delivery of the program in Australia, and some significant associations between practitioner characteristics and knowledge levels, which will be important for education providers to note. Targeted educational interventions informed by these findings could support health professionals to better translate guidelines into practice and ensure successful delivery of this important public health program, particularly in regard to management of immune-deficient women, screening after hysterectomy and indications for self-collected screening.