SURVEILLANCE FOR EQUITY IN CERVICAL CYTOLOGY SCREENING

Background. The opportunistic basis on which screening has been conduc ted in South Africa has resulted in multiple rescreening of a small pr oportion of the population (which excludes most women at high risk) an d low population coverage. There has consequently been a failure of sc reening to impact on the incidence of cervical cancer in most of the p opulation. Aim. To propose the use of the ratio of smears showing cerv ical intra-epithelial neoplasia (CIN) III :smears showing signs of mal ignancy as an indicator for the surveillance of equity in cervical cyt ology screening, and to apply this indicator to an area of the Western Cape of South Africa. Results. Marked inequity in screening is demons trated between metropolitan and non-metropolitan areas, and between di fferent non-metropolitan districts. Inequity in screening between diff erent age groups of women is also found, and this is associated with a n inappropriately young age distribution of screening activity. Conclu sion. The application of this indicator in the routine surveillance of screening activity may be useful in monitoring progress towards the i mplementation of more equitable screening programmes, and the validity of the indicator should be tested in other settings.