Technical, legal and ethical framework of cancer audit in cervical screening – Summary of best practices for organised programmes delineated through an expert group consultation

Efficient and well-organised cervical screening programmes have significantly reduced both the incidence and mortality rates of cervical cancer in the population. For optimal performance, such programmes need to incorporate essential quality assurance measures. The International Agency for Research on Cancer (IARC/WHO) organised an expert consultation to delineate best practices in auditing cancers in a cervical screening programme, the legal and ethical frameworks governing such audits, and communicating audit outcomes. As a best practice, every programme should have a well-documented policy and process framework for cancer audits. The TWGs agreed that the primary goal of programmatic cancer audits is to assess the programme's effectiveness in lowering cervical cancer incidence and minimising screening-related risks. Using audit results, informed decisions can be made to enhance service delivery, including professional training, adopting improved screening tests, strengthening fail-safe mechanisms, reducing delays, and minimising inequalities. Legal complexities in cervical screening stem from its inherent limitations and risks, and differentiating cases of negligence from inevitable and non-negligent errors where an abnormality is not detected but actually exists is crucial. TWGs suggested that determining whether a screening error was serious enough to be categorised as negligent and/or to entitle the patient to compensation should reflect the inherent limitations of cervical screening. Data obtained while performing screening tests and subsequent diagnostic tests or treatments are sensitive and need to be safeguarded. The best practice document drafted through expert consultation will help cervical screening programmes standardise practices related to cancer audits and address associated legal and ethical issues.