Evaluation of a Model Demonstration Program for the Control of Cervical Cancer in Rural China

Abstract

Background: Since 2009, a nationwide free cervical cancer screening project in rural China has been gradually expanded. The rapid expansion of cervical screening programs in China requires monitoring its progress and evaluating its results to improve the quality and effectiveness of control of cervical cancer. Here, we evaluated a demonstration screening program in rural China with a special focus on the coverage and outcome impact. We also explored practical factors that affect participation rate. Our ultimate goal was to facilitate the development of the comprehensive guidelines for quality assurance for cervical cancer screening in Rural China. Methods: The organized cervical cancer screening program in Zhushan county was evaluated for both ongoing activities and outcome impact from 2009 through 2014. A descriptive analysis of performance indicators and outcome measures related to screening was conducted. Performance indicators used in this study include screening coverage, recall rate, percentage of abnormal smears, precancer and cancer detection rate, treatment rate, incidence rate. The individual screening information from 2009 through 2014 was extracted from the screening institution in Zhushan county. Cervical cancer patients' information was collected from two county-level hospitals and three tertiary hospitals. Screening data were also linked to the population and the climate data to explore the practical factors that affect participation rate in the screening program. Results: Of the 73,847 pap tests performed in 2009-2014, 69127 (93.6%) were in the target age group (25-64). The screening coverage by township was between 10% and 30% in each 2-year screening round. About half of eligible women underwent at least once Pap test over the six-year period. The recall rates for the second and third period were 11.3% and 17.2%, respectively. The annual truncated age-standardized incidence rate varied among the first four years after the initiation of the organized screening program and dropped in the latter two years. After adjusting for other variables, the monthly maximum temperature interval had a significant association with the participation rate. When screening practice was implemented in low-temperature seasons (< 15 degrees), the participation rate would drop about 11 percent on average comparing to that in moderate temperature seasons. While screening practice was implemented in high-temperature seasons > 28 degrees), the participation rate would drop about 4 percent on average comparing to that in moderate temperature Conclusion: Our results indicate that the cervical cancer screening program in Zhushan county was successful in terms of decreasing the cervical cancer burden. Participation in organized screening programs and further expansion of the national-based screening programs should be encouraged. Cervical screening institutions should plan screening practice in moderate temperatures seasons (spring and autumn) in advance. There is an urgent need to develop the comprehensive national guideline for quality assurance for cervical cancer screening utilizing the important findings of this study.