Quality indicators for cervical screening in Sweden

Objectives Comparisons and optimization of screening programs are based on quality indicators (QI), but these are not well standardized and commonly not published. We report 13 QIs used for cervical screening in Sweden. These are decided on by the authorities and reported by the Swedish National Cervical Screening Registry that collects all data and calculates the QIs. The QIs as well as trends discovered and observations made during recent years, including effects of the COVID-19 pandemic, are summarized. Setting Sweden. All units involved in cervical screening export all individual data to the screening registry. Methods All data on screening invitations, cervical samples with human papillomavirus (HPV), cytology and histopathology results, as well as population data, cervical cancer cases and mortality, were collected. The 13 QIs were calculated. Results The HPV screening test had a high population coverage of 83%, with most primary screenings using self-sampling. Follow-up for women with CIN2+ (cervical intraepithelial neoplasia) in cytology within 3 months was 60%, increasing to 95% or more after 1 year. The incidence and mortality of cervical cancer have decreased in recent years. Some QIs became outdated due to program changes, and there was significant variability between regions. Conclusions The population coverage of the HPV screening test was not affected by the cancellation of screening appointments during the pandemic, because of switching to primary self-sampling. Improving follow-up of screen-positives and boosting population test coverage using HPV self-sampling are key areas for potential improvement.