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The role of cancer registries in
the evaluation of organised
screening
UKACR-NCIN London 16.6.2011
Stefan Lönnberg
PURPOSE OF POPULATION-BASED
CANCER SCREENING
• Prevent mortality from invasive cancer, cervical
•
cancer incidence can also be prevented
Improve quality of life
• Lighter treatments with early detection
• Limit adverse aspects of testing and management
• Improve quality and availability of the quality-
assured diagnostic and treatment services for
cancer and precancer
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Monitoring of performance
• Invitation of target population
• Attendance
• Results of screening tests
• Unsatisfactory tests
• Compliance to follow-up or management
• Interval cancers
• Audit of all cancers
CR in evaluation of screening
• Cancer burden outside of programme
• Time trends of inc and mort in relation to
screening intensity
• Audit of case histories: interval cancers
• Cytological audit: false negative tests
• Observational studies on screening effect
by screening history
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WP5: Interface of cancer
registries with cancer screening
programmes Objectives:
Improve cancer registration essential to
monitoring, quality assurance (QA) and evaluation
of cancer screening programmes
– Standards and procedures on cancer and screening
registries as detailed in the European QA guidelines for
cancer screening through
– Promotion of collaborative projects developed between
more experienced registries and those in new EU
member states and applicant countries
Eurocourse WP5 Recommendations
• Items and procedures of cancer
registration:
– Requirements for individual linkage
– Mode of detection
– QC of cancer registry and the screening
registry
– Which precancers to register?
– Coding of multiple primaries
– And more issues…
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Eurocourse WP5 Recommendations
• Screening-related data items:
– Suggestion on items and coding
structure for a standard screening
register data
– A proposal to develop a web-based
aggregated data input and output portal
for monitoring of the programmes
Eurocourse WP5 Recommendations
• European joint research proposals
Linkage studies & new pilot
programmes
Complementary interventions on
screening and primary prevention
Research priorities for potential new
cancer screening programmes
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Lönnberg et al. Cancer Epidemiol Biomarkers 2010
Lönnberg et al. Cancer Epidemiol Biomarkers 2010
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Performance across
laboratories
Sensitivity and specificity of rereading
ASC-US+
LSIL+
100
100
G
90
D
80
F
80
70
B
70
F
Sensitivity (%)
Sensitivity(%)
90
60
A
C
50
40
30
E
20
B
60
50
2
R =0.80
G
A
C
40
30
E
20
10
D
10
2
R =0.43
0
0
0
2
4
6
8
100-specificity (%)
10
12
0
1
2
3
4
5
6
100-specificity (%)
Lönnberg et al. Cytopathol 2011
Performance across
laboratories
Lönnberg et al. Cytopathol 2011
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Conclusions from audit
• 23% of CIN3+ cases originally Pap
I were false negative, only 5% of
all CIN3+ cases
• Difficult to increase Se without
losses in Sp
• Poor reproducibility; affects testing
and pre-cancer treatment burden
Conclusions from audit
•
•
•
Large variations in performance
indicators between laboratories
Impact on cancer prevention is not
obvious
• Screening depends on repeated smears
Evaluation and feed-back must be
continuous
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Screening historyScreening
of ICC cases
history of ICC deaths
2000-2008
2000-2008
below age
non-attend
screenover age below age
no invinterval non-attend
13%
4%
21%
15%
over age
interval
2%
2%
screen
no inv
22%
6%
N=1378
54%
32%
24%
6%
N=454
Next…
• Incidence and mortality outcome
calculations
• Case-control analysis of screening
history
• Cytological audit
• Biomarkers
• Histological audit
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Thank you for your attention
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