Transcript Public and private sector cervical cytology laboratories were

Assessment of Cervical Cytology Services in
the Republic of Moldova
and
Recommendations Reorganisation
Dr Philip Davies
1
Methods
1) Partnership established between the National Society of
Pathology of Moldova (NSPM) and the Società Italiana di
Anatomia Patologica e Citologia (SIAPEC)
2) Public and private sector cervical cytology laboratories were
identified through NSPM and Compania Naţională de Asigurări
în Medicină (CNAM)
3) A comprehensive questionnaire was sent each laboratory
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•
Number of Pap tests processed in 2015
Pap test results
Number and qualifications of staff
Capacities and condition of facilities
Types and condition of equipment
Etc.
4) All laboratories were visited from 14-18 March 2016
Results
1) 28 laboratories were
identified, 25 laboratories
participated.
2) 236,579 Pap tests were
reported in 2015 – enough to
screen 72.3% of the target
population.
3) Similar numbers of Pap tests
were reported in previous
years
4) Organised screening in
Western Europe with
coverage of 70% or more saw
reductions in cervical cancer
rates of up to 80%.
Cervical Cancer Rates & Stage at Diagnosis
1) No statistically significant year-to-year changes in cervical
cancer incidence, mortality or the proportion of cancers
diagnosed in Stages III+IV
2) Therefore, all the resources that are currently being expended
on cervical cancer screening are producing no effect what-soever and are being completely wasted
Why?
1) Cervical cytology in RM is being conducted without anyS
evidence-based, nationally approved:
• Training curricula, training standards or certification criteria,
• Working practice recommendations or clinical guidelines (Standard Operating
Procedures exist but are not used)
• QA procedures with performance indicators or standards,
• System to monitor and evaluate cervical cytology.
2) As a result, there is no way to:
• Ensure the cyto-screeners have the skills to do their job properly,
• Ensure cervical cytology laboratories follow evidence-based best practice
recommendations,
• Objectively measure the performance of cytology laboratories,
cyto-screeners or cytopathologists,
• Identify suboptimal performance and take steps to improve it.
Why?
Two of the most basic EU
cervical cytology lab
recommendations:
• All labs should screen >15,000
Pap tests / year
• All labs should have at least 4
cyto-screeners
1) Only 7 of 25 labs process
15,000 or more Pap tests /
year
2) Only 3 of 25 labs meet both
recommendations
3) If we added any other EU
recommendation, NO labs
would comply
4) Only need 4-5 labs anyway
1) In the absence of a QA process, comparing proportions of abnormal
results gives an indication of the quality of cervical cytology
2) Large variations between the labs indicates equally large variations
in the quality of their work
3) Numbers of abnormal Paps are much too low – a lot of disease is
missed and some of these women will needlessly develop cancer
Summary
1) The resources currently be expended in RM should be enough to
screen 72.3% of the target population.
2) Cervical cytology in RM is conducted opportunistically without:
• Training curricula, training standards or certification criteria,
• Working practice recommendations or guidelines,
• QA procedures with performance indicators or standards,
• System to monitor and evaluate cervical cytology.
3) Therefore, screening is having absolutely no effect on cervical
cancer rates
4) All these resources are being completely wasted and
5) Screening is producing a range of harms women being screened
• False negative tests lead to delays in diagnosing cervical pre-cancer and
some of these women will needlessly develop invasive cervical cancer,
• False positive tests lead to unnecessary follow-up procedures with adverse
sequelae, stress, costs for the women and the health system, etc.
Conclusion
The current situation with cervical cancer screening in RM is:
1) Not helping the women who are being screening but instead
causing them harm
2) A complete waste of scarce health care resources
3) Unjustifiable, unsustainable and unethical
The solution is simple:
Serious efforts must be undertaken now to implement the
recommendations that were provided in February 2014 and
move forward with implementing an organised cervical
screening program.
Thank you for your attention
10
Liquid-Based Cytology
Conventional Romanowsky stained Pap tests vs LBC:
1) No difference in the detection of high-grade disease
2) Results for all categories using conventional and LBC are too low
and a lot of disease is being missed using either technique