Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France

PLoS One. 2020 Feb 13;15(2):e0228660. doi: 10.1371/journal.pone.0228660. eCollection 2020.

Abstract

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d'information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cervix Uteri / pathology
  • Cervix Uteri / virology
  • Colposcopy / economics
  • Conization
  • Cross-Sectional Studies
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / methods*
  • Female
  • France / epidemiology
  • Health Care Costs
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods*
  • Middle Aged
  • Papillomavirus Infections / virology
  • Squamous Intraepithelial Lesions / diagnosis*
  • Squamous Intraepithelial Lesions / economics
  • Squamous Intraepithelial Lesions / epidemiology
  • Squamous Intraepithelial Lesions / therapy*
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Dysplasia / economics
  • Uterine Cervical Dysplasia / epidemiology
  • Uterine Cervical Dysplasia / virology
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / epidemiology
  • Vaginal Smears / economics
  • Vaginal Smears / methods

Grants and funding

The study was supported by SPMSD / MSD Vaccins. André Dahlab, Xavier Bresse and Mathieu Uhart are former employees of SPMSD. MSD Vaccins. Xavier Bresse is an employee of MSD vaccins. SPMSD / MSD Vaccins were involved in the study design, data analysis, decision to publish, and preparation of the manuscript. Charlotte Cancalon, Audrey Lajoinie and Stève Bénard are employees of stève consultants. stève consultants did not fund the study but was in charge of designing and performing the study. Yann de Rycke, Florence Tubach, Alexandre Lafourcade, Sylvie Guillo and Marie Dalichampt received no specific funding for this work. Christine Bergeron and Hélène Borne have been rewarded by SPMSD / MSD Vaccins as members of the study Independent Scientific Committee.