Cervical cancer screening in pregnancy: a review of specific indications in the Italian regions

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Abstract Introduction Cervical cancer represents the second most frequently diagnosed cancer during pregnancy. Screening programmes have allowed earlier diagnosis and greater treatment options. Many studies have confirmed that Pap smear testing is safe during pregnancy, but some healthcare workers are still reluctant to perform them in fear of adverse pregnancy outcomes. This work aims to systematically evaluate the presence of specific indications on Pap smear during pregnancy in the protocols of organized screening programmes across all Italian regions. These would reassure the healthcare professionals when screening pregnant women. Methods We carried out a research on Google and also on the official websites of all 21 Italian regions/autonomous provinces, gathering all cervical screening related documents. If the organized screening protocols did not include indications on Pap smear during pregnancy, clinical or technical documents with detailed descriptions of the cervical screening pathway were selected. Subsequently, we summarized the collected evidence for all regions: presence of a comprehensive protocol for cervical screening, the provision of indications for pregnant women, and their consistency with national guidelines. Results 20 out of 21 regions had comprehensive protocols for the standardised provision of cervical screening within the organised, publicly funded, programmes. Only five out of these 20 included indications specific for pregnant women, and all these were consistent with the guidelines provided by national scientific societies. Conclusions Our comprehensive analysis of cervical screening documents provided by Italian regions showed an alarming lack of specific indications on the execution of screening Pap smears in pregnant women. Clear indications should instead be widely available to screening staff, in order to appropriately perform cervical screening of pregnant women. Key messages Only a minority of the Italian regions explicitly included indications for Pap smear execution during pregnancy. The presence of these indications is strongly warranted as it would allow timely, safe, and appropriate cervical screening also for pregnant women.

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