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  • Measure Summary
  • NQMC:010922
  • May 2016

Cervical cancer screening: percentage of invasive carcinoma of the cervix diagnosed at stage 1 in a 12-month period.

Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring & evaluation of quality indicators. Toronto (ON): Canadian Partnership Against Cancer; 2016 May. 81 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Primary Measure Domain

Population Health Quality Measures: Population Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of invasive carcinoma of the cervix diagnosed at stage 1 (International Federation of Gynecology and Obstetrics [FIGO] stage) in a 12-month period.

Rationale

The introduction of cervical cancer screening using the Papanicolaou test (Pap test) has led to significant reductions in cervical cancer incidence and mortality in Canada. From 1977 to 2015, the incidence of invasive cervical cancer declined from 15.4 per 100,000 to an estimated 7.5 per 100,000 and invasive cervical cancer mortality declined from 4.8 per 100,000 to an estimated 1.6 per 100,000 (Canadian Cancer Society, Advisory Committee on Cancer Statistics, 2015). Despite this success, in 2015, an estimated 1,500 Canadian women will be diagnosed with invasive cervical cancer and 380 will die from the disease (Canadian Cancer Society, Advisory Committee on Cancer Statistics, 2015). Many of these women were not screened in the five years before their diagnosis, were not followed up appropriately after an abnormal Pap test result, or the Pap test failed to detect their cancer. Additionally, women with lower levels of income, education, new immigrants, women living in rural or remote locations, and who have limited access to screening are less likely to be screened (Canadian Partnership Against Cancer, 2014). For these reasons, it is critical to continuously monitor and evaluate cervical cancer screening to ensure that Canadian women receive high-quality cancer prevention services.

Cancers diagnosed at stage 1 (or the early stage invasive cancer detection rate) is the percentage of invasive cervical cancers diagnosed at stage 1 in a 12-month period using the International Federation of Gynecology and Obstetrics (FIGO) stage classification system. Stage 1 is the earliest stage where the cancer has invaded the cervix but is not growing outside the uterus (Benedet et al., 2000). Stage at diagnosis is strongly related to survival (Henley et al., 2010). Therefore, although the primary goal of cervical screening is the prevention of cervical cancer, a secondary benefit of screening is the diagnosis of cervical cancer earlier when it can be more easily treated and with greater chances of cure.

Evidence for Rationale

Benedet JL, Pecorelli S, Ngan HYS, Hacker NF. Staging classifications and clinical practice guidelines of gynaecological cancers, 2nd edition. Amsterdam (Netherlands): Elsevier; 2000.

Canadian Cancer Society, Advisory Committee on Cancer Statistics. Canadian cancer statistics 2015. Toronto (ON): Canadian Cancer Society; 2015. 151 p.

Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring & evaluation of quality indicators. Toronto (ON): Canadian Partnership Against Cancer; 2016 May. 81 p.

Canadian Partnership Against Cancer. Examining disparities in cancer control: a system performance special focus report. Toronto (ON): Canadian Partnership Against Cancer; 2014 Feb. 88 p.

Henley SJ, King JB, German RR, Richardson LC, Plescia M, Centers for Disease Control and Prevention (CDC). Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) - United States, 2004-2006. MMWR Surveill Summ. 2010 Nov 26;59(9):1-25. PubMed External Web Site Policy

Primary Health Components

Cervical cancer screening; invasive cervical cancer

Denominator Description

Number of invasive cervical cancers

Numerator Description

Number of invasive cervical cancers diagnosed at stage 1 (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Cervical cancer is caused by infection with the human papillomavirus (HPV) (Trottier & Franco, 2006; Dawar, Deeks, & Dobson, 2007). Of the more than 100 types of identified HPV, 40 infect the genital tract; of these, approximately 15 are considered high risk, with types 16 and 18 causally linked to 70% of cervical cancer cases. HPV is a highly prevalent sexually transmitted virus; peak prevalence occurs during adolescence and the early 20s after the commencement of sexual activity.

Most HPV infections are transient and are cleared by the immune system without signs or symptoms. However, a small percentage of women experience persistent infections. For these women, the average time between becoming infected with a high risk HPV type and developing a pre-cancerous lesion is 24 months, with a further eight to 12 years before the development of invasive cervical cancer. Because of this long latency period, screening is an effective strategy for the identification and treatment of pre-cancerous cervical lesions.

Evidence for Additional Information Supporting Need for the Measure

Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring & evaluation of quality indicators. Toronto (ON): Canadian Partnership Against Cancer; 2016 May. 81 p.

Dawar M, Deeks S, Dobson S. Human papillomavirus vaccines launch a new era in cervical cancer prevention. CMAJ. 2007 Aug 28;177(5):456-61.

Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine. 2006 Mar 30;24 Suppl 1:S1-15. PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Monitoring health state(s)

National reporting

Population health improvement

Measurement Setting

Ambulatory/Office-based Care

State/Provincial Public Health Programs

Professionals Involved in Delivery of Health Services

Physicians

Public Health Professionals

Least Aggregated Level of Services Delivery Addressed

State/Provincial

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age 21 to 69 years

Target Population Gender

Female (only)

Public Health Aims for Quality

Health Promoting

Population-centered

Vigilant

National Quality Strategy Aim

Healthy People/Healthy Communities

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

  • January 1, 2011 to December 31, 2011
  • January 1, 2012 to December 31, 2012
  • January 1, 2013 to December 31, 2013

Denominator Sampling Frame

Geographically defined

Denominator (Index) Event or Characteristic

Clinical Condition

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of invasive cervical cancers

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of invasive cervical cancers diagnosed at stage 1

Note:

  • Map TNM Classification of Malignant Tumours (TNM) to International Federation of Gynecology and Obstetrics (FIGO) stage (T1=I, T1A=IA, T1a1=IA1, T1a2=IA2, T1b=IB, T1b1=IB1, T1b2=IB2) before submission.
  • Define age as the woman's age at diagnosis (pathology/biopsy).
  • Invasive cervical cancers include squamous cell cancers, adenocarcinoma, adenosquamous, and not classified, i.e., all cases with an International Classification of Diseases for Oncology (ICD-O) C53 topography code.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

State/Province public health data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • International Federation of Gynecology and Obstetrics (FIGO) staging system
  • Cervical Cancer Screening Pathway with Quality Indicators

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

Calculate age-specific rates.

Age Groups: 21-29, 30-39, 40-49, 50-59, 60-69

Data will be rolled up to provide a national percentage by age group.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

11. Percentage of cancers detected at stage 1.

Measure Collection Name

Cervical Cancer Screening Indicators

Submitter

Canadian Partnership Against Cancer - National Government Agency [Non-U.S.]

Developer

Canadian Partnership Against Cancer - National Government Agency [Non-U.S.]

Public Health Agency of Canada - National Government Agency [Non-U.S.]

Funding Source(s)

A financial contribution from Health Canada, through the Canadian Partnership Against Cancer

Composition of the Group that Developed the Measure

Pan-Canadian Cervical Cancer Screening Monitoring and Evaluation Working Group

  • Kathleen Decker (Chair, Monitoring and Evaluation Working Group)
  • Meg McLachlin (Chair, Pan-Canadian Cervical Cancer Screening Network)
  • Monique Bertrand (Society of Obstetricians and Gynecologists of Canada)
  • Robert Grimshaw (Cancer Care Nova Scotia)
  • Erika Nicholson (Cancer Care Nova Scotia)
  • Dirk van Niekerk (British Columbia Cancer Agency)
  • Laura Gentile (British Columbia Cancer Agency)
  • Huiming Yang (Alberta Health Services)
  • Gordon Kliewer (Alberta Health Services)
  • Wanda Fiessel (Saskatchewan Cancer Agency)
  • Kimberly Templeton (CancerCare Manitoba)
  • Anna Kone (Cancer Care Ontario)
  • Rachel Kupets (Cancer Care Ontario)
  • Shirley Koch (New Brunswick Cancer Network)
  • Réjean Savoie (New Brunswick Cancer Network)
  • Ann Millar (Health PEI)
  • Joanne Rose (Cervical Screening Initiatives Program, Newfoundland and Labrador)
  • Kami Kandola (Department of Health and Social Services, Northwest Territories)
  • Verna Mai (Canadian Partnership Against Cancer)
  • Diane Major (Canadian Partnership Against Cancer)
  • Carol Irwin (Canadian Partnership Against Cancer)

Pan-Canadian Cervical Cancer Screening Monitoring and Evaluation Data Group

  • Jeremy Hamm (British Columbia Cancer Agency)
  • Colleen Mcgahan (British Columbia Cancer Agency)
  • Linan Xu (Alberta Health Services)
  • Tong Zhu (Saskatchewan Cancer Agency)
  • Natalie Biswanger (CancerCare Manitoba)
  • Julia Gao (Cancer Care Ontario)
  • Bin Zhang (New Brunswick Cancer Network)
  • Devbani Raha (Cancer Care Nova Scotia)
  • Patricia Lush (Health PEI)
  • Jeff Dowden (Newfoundland and Labrador Centre for Health Information)
  • Yalda Jafari (Population Health, Northwest Territories)

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 May

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Source(s)

Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring & evaluation of quality indicators. Toronto (ON): Canadian Partnership Against Cancer; 2016 May. 81 p.

Measure Availability

Source available from the Canadian Partnership Against Cancer Web site External Web Site Policy.

For more information, contact the Canadian Partnership Against Cancer at 1 University Ave, Suite 300, Toronto, ON, Canada M5J 2P1; Phone: 1-877-360-1665; E-mail: info@cancerview.ca; Web site: www.cancerview.ca External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 22, 2016. The information was verified by the measure developer on September 27, 2016.

The information was reaffirmed by the measure developer on February 1, 2017.

Copyright Statement

No copyright restrictions apply.

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