Assessment of the Effectiveness of Cervical Cancer Screening in Tbilisi

Abstract

According to the US Center for Disease Control (CDC 2013), a reliable statistical tendency of decreasing cervical cancer incidence and mortality caused by this disease has been recorded in the United States over the recent 40 years that
relates to high rate coverage of a female population by Pap test screening. This tendency is proved by American Cancer Society (ACS, 2012). According to Gold M.A. (2006), 70-80 % decrease of cervical cancer incidence has been
achieved by Pap test screening in developed countries. According to the Norwegian Cervical Cancer Screening Program (NCCSP, 2014), screening has contributed to 25 % decrease of cervical cancer incidence and 50 % decrease of
mortality caused by this disease in Norway. According to Nanda K. et al. (2000) data, in case of cervical cancer CIN
2/3, Pap test sensitivity and specificity vary within the range 47 % - 62 % and 60% - 85% correspondingly. We have
studied the cost-effectiveness of cervical cancer screening program, based on 5 year period data (2010–2014): 66,324
women received gynecological examination and Pap test and 12,147 received colposcopy, targeted biopsy and morphological analysis. In 2013, 13,584 women received cervical cancer screening, among them 7,416 women at the National Screening Center (NCC). The indicators of diagnostic effectiveness of gynecological examination, Pap test, colposcopy and combination of a Pap test and colposcopy have been studied based on NCC data with a purpose of assessment. In 2013, the prevalence of severe cervical dysplasia (CIN3) and intraepithelial carcinoma (CIS) per 1,000 female
population eligible for screening constituted 9,8 % and cancer prevalence was 6,1 %. The study has found that making
of alterations in a screening guideline and re-adjusting of a target group from 25-59 to 30-64 age group will increase
the number of detected cervical cancer cases and decrease needed expenditures: in case of 50 % coverage of a target
group by ~93,000 GEL and by ~130,000 GEL in case of 70 % coverage. i.e. making of alterations to the screening
guideline and re-adjusting of a target group to 30-64 age group will significantly enhance the cost-effectiveness of cervical cancer screening.