Women in the denominator who have not undergone cervical cancer screening cytology (Pap test) at least once in the past five years
Women aged 29-53
Cervical cancer is a malignant disease caused mostly by an infection with Human Papilloma Virus (HPV). Although there is a vaccination against the virus, the recommendation is still to perform early detection screenings for the disease (1). Cervical cancer meets the criteria for screening and early detection, due to its long latency period, the existence of pre-cancerous lesions, and the availability of treatment that can prevent progression to malignancy (2). The main goal of screening is to detect these pre-malignant lesions and provide preventive treatment before they become cancerous. Most developed countries recommend early detection screening for cervical cancer, either through organized programs or opportunistic screening, using the Pap smear test every three years for women aged 25 to 65 (2)(3)(4). Recently the recommendation was changed to include screening for the HPV virus once every 5 years for women between the ages of 30-50(5). Currently in Israel, women between the ages of 25-54 are covered by the national health plan for a pap smear once every 3 years or an HPV test once every 5 years (6). Women between the ages of 55-64 are eligible for a cervical smear once every 5 years (6). Since 1996 and until 2021, mortality rates from cervical cancer have been stable among Jewish women in Israel but increased among Arab women (7). In countries with established screening programs, a significant decline in cervical cancer incidence and mortality has been observed, with most cases now occurring in women who were not adequately screened (2)(3)(8)(9).
1. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. *Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement*. JAMA [Internet]. 2018;320:674–686. Available from: [JAMA Cervical Cancer Screening Recommendation Statement](https://jamanetwork.com/journals/jama/fullarticle/2697704?utm_source=chatgpt.com)
2. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, et al. *American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer*. CA Cancer J Clin. 2012;62(3):147–172.
3. Dollin J. *Recommendations on Screening for Cervical Cancer*. Can Med Assoc J. 2013;185(1):13–14.
4. Israeli Society of Obstetrics and Gynecology. *Proposal for Update of Position Paper No. 101: Cervical Smear as a Screening Test for the Prevention of Cervical Cancer*. 2015;3. Available from: [Position Paper No. 101 PDF](https://cdn.mednet.co.il/2015/04/נייר-101-סקר-פאפ-18.3.15-עדכון-1.pdf?utm_source=chatgpt.com)
5. Ministry of Health. *Cervical Cancer in Israel – Data Update, January 2019*. 2019;1–10.
6. World Health Organization. *Cervical Cancer* [Internet]. 2018. Available from: [WHO Cervical Cancer Fact Sheet](https://www.who.int/news-room/fact-sheets/detail/cervical-cancer?utm_source=chatgpt.com)
7. Quinn M, Babb P, Jones J, Allen E. *Effect of Screening on Incidence of and Mortality from Cancer of the Cervix in England: Evaluation Based on Routinely Collected Statistics*. Br Med J. 1999;318(7188):904–908. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
7. Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: Evaluation based on routinely collected statistics. Br Med J. 1999;318(7188):904–8.
