Cervical Cancer Screening

Answer

Cervical Cancer Screening

            In their study, Nieminen et al. (1999) compared the effect of organized and spontaneous Pap smear screening on the occurrence of invasive cervical carcinoma. The purpose of this essay is to review Nieminen et al.’s (1999) study and respond to the provided questions. Issues addressed include providing an explanation of statistical results, evaluate effectiveness of organized Pap smear screening, interpret odd ratios, and identify confounding variables. Besides, the obstacles to implementing organized-screening system for cervical carcinoma in the United States are presented. Organized screening is more effective in reducing the relative risk of invasive cancer of the cervix compared to spontaneous screening.

            Statistical results for organized and spontaneous Pap smear screening indicate that both can lower the relative risk of invasive cancer of the cervix. It was established that spontaneous screening [odds ratio (OR) was 0.82 (with 95% confidence-interval (CI) 0.53-1.26)] had a weaker effect in lowering the relative risk of invasive cancer of the cervix compared to the effect of among the participants in the organized-screening program [OR was 0.38 (95% CI 0.26-0.56)].  Thus, organized screening may be more favourable than spontaneous Pap smear for evaluating the risk of invasive cancer of the cervix cancer for screening purposes (Nieminen et al., 1999).

            Organized Pap smear screening can be concluded as a better approach than spontaneous Pap smear screening for lowering the relative risk of invasive cancer of the cervix. Organized-screening would be less costly and more effective in engaging all women in planned screening rather than waiting for women to decide on their own to visit a gynaecologist and be screened spontaneously. In this approach, all women in a given location will be scheduled a particular date in the year depending on the period in which they will be screened for cancer. It serves all women since even those who may have low level of education and are not aware about the need to visit gynaecologists for cervical cancer screening will always be reminded by a letter or via any other communication channels such as phone calls. Apart from saving on costs, organized cervical cancer screening can be better be budgeted for and has been found to result lower relative risk for development of invasive cervical carcinomas compared to spontaneous screening (Nieminen et al., 1999).

            Both ORs for organized (OR 0.38) and spontaneous cervical cancer screening (OR 0.82) recorded some effect in lowering the relative risk of invasive carcinoma of the cervix. However, organized-screening had a superior effect in lowering the relative risk of invasive carcinoma of the cervix cancer compared to spontaneous screening since it has a smaller OR value (0.38) compared to spontaneous screening OR value (0.82). A smaller OR value indicates a stronger lack of correlation between the type of screening and the outcome, which in this case is the development of invasive carcinoma of the cervix. In fact, that is an expected outcome since the goal of cervical cancer screening is to achieve early detection and treatment before the cancer progress to advanced stages. In addition, the 95% for the OR values of both types of screening indicates that that there OR (0.38) of the organized screening (CI 0.26-0.56) is more precise in measuring the effect or outcome compared to OR (0.82) of the spontaneous screening (CI 0.53-1.26) since the lower the CI value the higher the level of precision of the OR (Nieminen et al., 1999; Szumilas, 2015). In lay terms, OR is the strength of the correlation between a given exposure/intervention and a specific defined outcome. OR shows the odds of the occurrence of a given outcome following a certain exposure compare to the occurrence of a similar outcome given the absence of the same exposure. If the outcome in the absence of a defined outcome then it implies that the occurrence may be influenced by other independent factors known as confounding factors.  If OR value is equal to one (1), then a given exposure does not determine odds outcome. If OR value is less than one (1), then a given exposure is associated with lower odds of a given occurrence or outcome. If OR value is greater than one (1), then a given exposure is linked with higher-odds of occurrence or an outcome (Szumilas, 2015).

            There are some potential confounding factors in the study. A major confounding factor that was obviously overlooked in the study was whether the participants or controls had been diagnosed of human papillomavirus (HPV) infection or not. HPV is the primary risk factor for development of the cancer of the cervix; therefore, it might have increased the risk for emergence of cervical cancer regardless one attended spontaneous screening or participated in organized screening programme (Brisson et al., 2020). A key confounding factor that was described by Nieminen and colleagues (1999) was smoking. Smoking had a significant effect (OR 3.321; CI 2.14-4.80) in elevating the relative risk of cervical cancer compared with smokers among all participants in all three interventions; which were, control group, organized screening group, and spontaneous screening group. Other confounding factors in the study included age of the participant, parity, and social class (Nieminen et al., 1999).

            There may be some obstacles to implementing a similar organized screening system for cervical cancer in the U.S. Some of the key obstacles would include current existing guidelines and healthcare policies. Current guidelines by the American Cancer Society (ACS) exclude women younger than 30 years and older than 65 years in 5-yearly screening for cervical cancer that include Pap test and HPV DNA test (Smith et al., 2019). Pap test alone is done every 3 years according to recommendations by ACS (Smith et al., 2019) rather than every 5 years as suggested in Nieminen et al.’s (1999) study. In addition, organized screening is currently barred for women who are over 65 years who have had at least 2 consecutive negative HPV DNA tests and Pap test within the past 10 years or have had at least 3 consecutive negative Pap tests with the past 10 years (Smith et al., 2019). Besides, women who have gone through total hysterectomy are advised to stop screening for cervical cancer (Smith et al., 2019).