October 2, 2025Open Access

Impact of government-organized screening programs on the economic burden of cervical cancer across five disease courses: a multistage regression and mediation analysis

MDMingjie DongChinese Academy of Medical Sciences & Peking Union Medical College JXJiaxin XieFirst Affiliated Hospital of Guangzhou University of Chinese Medicine XZXuelian ZhaoChinese Academy of Medical Sciences & Peking Union Medical College

Key Points

Government-organized screening leads to a lower economic burden in cervical cancer patients, improving resource utilization.
Workplace and self-paid check-ups result in progressively higher costs across diagnosis, initial treatment, and follow-up stages.
Multicentre survey across 26 hospitals in China employed multivariable regression and mediation analysis to assess screening impacts.
Findings suggest earlier diagnosis and reduced overtreatment translate into clinical benefits and increased equity in cancer care.

Abstract

Objective: To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions, and explore mediating pathways across diagnosis, initial treatment, radiotherapy/chemotherapy, follow-up, and recurrence/progression/metastasis. Methods: A multicentre, nationwide survey across 5 disease courses was conducted from 26 hospitals in China. Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up, self-paid check-up, and symptom-based detection. Results: Workplace check-up, self-paid check-up, and symptom-based detection were associated with progressively higher costs across diagnosis : 1.10, 95 confidence interval (CI): 0.541.67; : 1.46, 95 CI: 1.001.92; and : 1.68, 95 CI: 1.252.11, respectively, initial treatment (: 0.36, 95 CI: 0.180.55; : 0.51, 95 CI: 0.350.66; and : 0.56, 95 CI: 0.420.70, respectively), and follow-up (: 0.63, 95 CI: 0.380.88; : 0.83, 95 CI: 0.611.04; and : 0.85, 95 CI: 0.651.06, respectively) compared to government-organized screening (all P 0.05). Earlier clinical staging and greater use of lower-level hospitals mediated 44.7454.97 of cost differences in diagnosis, 73.2785.04 in initial treatment, and 30.3854.73 in follow-up. Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions. Conclusions: Government-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis, reduced overtreatment, and decreased reliance on higher-level hospitals, suggesting potential clinical benefits, efficient resource use, and improved equity in cancer care.

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