Chronic Diseases in Canada

Volume 31, no. 1, December 2010

Executive summary – Performance monitoring for cervical cancer screening programs in Canada

Screening Performance Indicators Working Group, Cervical Cancer Prevention and Control Network

Correspondence: Jay Onysko, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, 785 Carling Ave., A/L 6809A, Ottawa, ON, K1A 0K9,
Tel.: (613) 952-6143, Fax: (613) 941-5497,
Email: jay.onysko@phac-aspc.gc.ca

The purpose of this report is to define a core set of performance indicators for organized cervical cancer screening programs in Canada.

The goals for establishing a pan-Canadian set of performance indicators are to promote high quality screening through monitoring and evaluation. Over time, with regular monitoring and reporting of these indicators, an evidence base will grow which will permit the setting of pan-Canadian targets.

Cervical cancer control is undergoing tremendous development as knowledge of the causal relationship between the human papillomavirus (HPV) and cervical cancer continues to increase. Regular monitoring and reporting of these indicators will facilitate the evaluation of the impact of new technologies and interventions.

The program performance indicators described were selected by the Screening Performance Indicators Working Group (SPIWG) through a consensus-based, iterative process. Feedback from content experts including researchers, clinicians and administrators across Canada was also sought.

The program performance indicators reflect the current pan-Canadian screening practices and include the following: coverage (i.e. participation and retention rates), cytology performance (i.e. specimen adequacy and Pap test results), system capacity (i.e. cytology turn-around time and time to colposcopy), follow-up (i.e. biopsy rate, cytology-histology agreement) and outcomes (i.e. pre-cancer detection rate, cancer incidence, disease extent at diagnosis: cancer stage, screening history in cases of invasive cancer).

The ongoing implementation of HPV immunization programs will have a significant future impact on cervical cancer in Canada. To detect changes in cervical cancer and cervical cancer screening attributable to HPV vaccine programs, the SPIWG recommends that relevant core performance indicators be monitored by 10-year age groups to detect early changes, and eventually by various HPV vaccination parameters (e.g. type of vaccine, fully/partially/not vaccinated, time since vaccination) to detect differences.

It is challenging to define quantifiable performance indicators over the entire spectrum of activity for an organized screening program especially given that the body of literature is continually evolving, as are the technologies and methods used to screen, diagnose and treat cervical cancer. In light of this, this core set of performance indicators is expected to be updated as pan-Canadian screening policy and management guidelines evolve over time. Future indicators should include areas such as professional education initiatives, public education initiatives, letters of invitation, recruitment initiatives, program efficiency, HPV testing protocols, HPV immunization, among others.

The implementation of HPV vaccine programs and the consideration of HPV testing as a primary screening test will require pan-Canadian experts to convene to develop new cervical screening policy and management guidelines. The SPIWG urges that the identification of performance indicators be included within the development of screening policy and management guidelines. This emphasizes the integral role of performance monitoring and evaluation in policy implementation.

Much of this document is highly technical; however, the Background and Future Directions sections and Appendix C provide a general overview of cervical screening in Canada and its evaluation.

For more information, the Report from the Screening Performance Indicators Working Group, Cervical Cancer Prevention and Control Network (CCPCN): January 2009 is available on the PHAC website at: http://www.phac-aspc.gc.ca/cd-mc/cancer/pmccspc-srpdccuc/index-eng.php