Background: In Poland in 2007, according to the National Cancer Registry 3431 women were diagnosed with cervical cancer and 1907 died. To change the unfavorable epidemiologic situation, in 2005 the Ministry of Health (MH), the National Health Fund (NHF) and the Polish Gynecological Society following WHO/IARC guidelines developed a National Population-Based Cervical Cancer Screening Program. Its implementation and roll-out started in 2006. The target population are women aged 25 to 59 insured in the National Health Fund. A Pap test is done with a three-year interval, free of charge. The system is based on personal invitations sent by regular post. Invitation to screening is supported by a social educational campaign "Choose Life" run under one slogan and logo across the whole country The NHF data base enables identification of women to screen. Pap smears are collected by gynecologists and since 2008 also by midwives trained and certified by the Program National Coordinating Center Pap test results are reported in the Bethesda 2001 system. The Screening Program has its system of quality assurance and control and is supported by a specially designed computer data base called SIMP (System of Information Monitoring in Prophylaxis) with online access to all records. In addition to organized, population-based screening there is also opportunistic screening in Poland practiced either by private gynecological practices or by some units that cooperate with the National Health Fund, but do Pap tests as an element of comprehensive gynecological examination. Those smears are not registered in the SIMP.
Aim: Our aim was analysis of attendance rate in the Cervical Cancer Screening Program in the years 2007-2009. We also investigated correlation between screening coverage and invitation sending schedule, as well as between coverage and screening accessibility determined by the number of gynaecological practices where Pap smears are collected.
Material and methods: Attendance rate in the Screening Program was evaluated for the years 2007, 2008 and 2009. The analysis included screening coverage in all voivodeships in the 12 months of the year as well as the number of gynaecological practices participating in the Program. In addition, the place of residence of screening attenders (urban/rural area) was taken into account. For the analysis the SIMP (System of Information Monitoring in Prophylaxis) data were used. Statistical analysis was performed using Statistica 9.0 software. P-values < 0.05 were considered statistically significant.
Results: The target population in the years 2007-2009 was 9,727,842 women. Personal invitations were sent to 99.7% of them. Pap Smears were collected from 24.14% of the target women (in 2007--21.25%; in 2008--24.39%; in 2009--26.77%). We noted that the number of 1400 gynecological practices participating in the Program was the minimal value to observe a significant increase in the number of Pap smears collected (p = 0.000). Polish women do not attend screening in the winter months. However when a batch of invitations was sent in the spring or summer months, within two following months we could observe an increase in the number of Pap smears collected (p = 0.000). There are significant differences in the screening uptake in particular regions of Poland (a stable trend). Compared to urban women, rural women participate in the screening more often (p = 0.003).
Conclusion: All Pap test results including opportunistic screening should be registered in the SIMP In the regions where particularly low attendance rates were observed, an intensive promotional campaign should be run to encourage participation in the screening. Also, sending a repeated invitation to non-compliers should be considered. The currently unfavorable schedule of invitation sending should be changed. According to the analysis performed, invitations should be more effective if sent on a regular basis (in small but regular batches), more intensively in the summer and spring months. In the winter season it would probably be better to focus on an extensive media campaign followed by sending a large number of personal invitations.