# Cervical Cancer Screening Cascade: A Framework for Monitoring Uptake and Retention Along the Screening and Treatment Pathway

## TL;DR

This paper introduces a framework to track and improve cervical cancer screening and treatment steps, aiming to reduce deaths by identifying where people drop out of the process.

## Contribution

The novel contribution is a structured Cervical Cancer Screening Cascade framework to monitor screening and treatment uptake and retention.

## Key findings

- The framework outlines four phases: screening, triage, detection, and treatment, each with specific substages.
- It can help identify gaps in follow-up and optimize resource allocation in HPV-based screening programs.

## Abstract

Cervical cancer is largely preventable, yet it continues to cause hundreds of thousands of deaths worldwide. Effective screening and treatment are key to reducing this burden, especially with the shift to human papillomavirus (HPV) testing as the primary, more effective screening method. However, many individuals do not complete all recommended steps, such as follow-up testing or treatment after receiving a positive screening result. This paper introduces a structured framework—the Cervical Cancer Screening Cascade—to help cervical screening programs monitor the proportion of eligible individuals completing each stage of the screening and treatment process. By identifying where drop-off occurs in the cascade of care, this framework intends to improve care delivery, inform policy, and support global efforts to eliminate cervical cancer.

Background: Cervical cancer is a major global health concern, causing approximately 350,000 deaths annually. It is also preventable through effective prevention and early detection. To facilitate elimination, the World Health Organization (WHO) set targets for HPV vaccination, screening, and treatment. Achieving these goals requires frameworks to monitor screening program performance. As many regions transition to HPV primary screening, a standardized Cervical Cancer Screening Cascade can track performance, identify gaps in follow-up, and optimize resource allocation. Methods: This paper introduces a structured cascade developed to monitor uptake, retention, and outcomes in HPV-based screening programs. The Cascade was created through collaboration between public health experts, clinicians, and researchers at the University of British Columbia (UBC), the Women’s Health Research Institute, and BC Cancer. Results: The Cascade outlines four phases: screening, triage, detection, and treatment. Each phase includes two substages: “uptake” and “results,” with an additional substage in screening (“invitation”). “Screening” assesses invitation effectiveness and participation. “Triage” tracks follow-up after a positive screen. “Detection” evaluates attendance at diagnostic appointments, and “Treatment” measures the treatment rate for those with precancerous lesions. Conclusions: The Cascade can guide emerging and existing HPV screening programs within Canada and other similarly resourced settings and serve as a benchmark tool for programs to assess their progress towards cervical cancer elimination.