INTERACTION OF SPONTANEOUS AND ORGANIZED SCREENING FOR CERVICAL-CANCER IN TURIN, ITALY

In a screening programme for cervical cancer, coverage of the target p opulation is a major determinant of effectiveness and cost-effectivene ss and is one of the parameters for programme monitoring recommended b y the ''European Guidelines for Quality Assurance''. An organised scre ening programme was started in Turin, Italy, in 1992. Spontaneous scre ening was already largely present, but coverage (proportion of women w ho had at least a test within 3 years) was low (<50%) and distribution of smears uneven. No comprehensive registration of spontaneous smears was available. All women were invited for the first round, independen tly of their previous test history. Coverage was estimated by integrat ing routine data from the organised programme with data on spontaneous screening obtained by interviews of a random sample of 268 non-compli ers to invitation and 167 compliers. Overall (spontaneous + organised) coverage was estimated to be 74% (95% CI, 71-78%). The proportion of the target population covered as an effect of invitation was estimated to be 17% (95% CI, 15-20%). Invitations were successful in increasing coverage in previously poorly screened groups. Although 20-25% of com pliers was estimated to have had further tests before the end of the r ound, we estimated that switching to a 3-year interval saved approxima tely 0.26 tests per complier. This suggests that invitations to an org anised programme even to previously covered women, can be a cost-effec tive policy. Our method of estimating overall coverage can be useful i n many other European areas where a comprehensive registration of smea rs is not available. (C) 1997 Published by Elsevier Science Ltd.