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Cervical cancer is the third most prevalent gynaecological cancer, after uterine body and ovarian cancers. Occurring in young women, with a peak of incidence around age 40 and death at 55 years, this cancer is one of the most marked by social inequalities. The women of the most disadvantaged social categories are those who combine both the most risk factors and poorer adherence to preventive measures that rely on vaccination against human papilloma viruses (HPV) and screening for early stage cervical lesions, starting at the age of 25 years. As almost every case of cervical cancer could be prevented by cervical screening and HPV vaccination. The different European countries have implemented cervical cancer screening practices, more or less systematic, and more or less effective, with rates of regular screening widely varying. Even in countries where this rate is high, such as Finland or Sweden, some women who are truly refractory to screening. This is a major health issue because these women are often at high-risk with a 5-year survival closely correlated with the stage of disease when discovered. The costs also increase exponentially depending on the cancer stage. Numerous randomized trials conducted around the world have attempted to improve the response rate in underscreened women. But unfortunately the response rate barely reaches 20% of these women. Many factors can explain the difficulties in obtaining a satisfactory screening rate, whether geographic distance, economic constraints, disengagement of general practitioners, education level or socioeconomic status. It is therefore a European public health problem for which we assembled a network of experts from 10 European countries (Belgium, Bulgaria, France, Germany, Ireland, Italy, Portugal, Romania, Spain, and Sweden), three research groups, the International Agency for Research on Cancer (IARC), the European Cervical Cancer Association (ECCA) and the Poverty Action Laboratory (J-PAL), and a representative association of patients, The European Institute of Women's Health (EIWH). These experts, clinicians and researchers, have expertise in screening for cancer, especially cervical cancers, in conducting large randomized clinical trials, in qualitative and quantitative analysis of social and cultural determinants, in analysis of social disparities and discrimination for access to care, or in modelling health policies. If all group members do not all have worked together in the past, numerous collaborations already took place within the group. The goal of our network is to file a research project for the H2020 SC1-PM-10-2017 call for proposal entitled “Comparing the effectiveness of existing healthcare interventions in the adult population.” This project aims to test, in partner countries, interventions to increase adherence to screening in underscreened women, with special attention, but not exclusively, to women of low socio-economic status; to evaluate the quality, and assess its drivers, of downstream management of abnormal screening findings; model interventions in different countries; to analyse the cost-effectiveness of the intervention; and finally to develop an implementation research to define the best strategy through European countries of different socioeconomic structures and disease prevalence levels. The project will be managed by a French coordinator and a steering committee of clinical researchers, and will be promoted and coordinated by the INSERM. The MRSEI funding will be used to strengthen interactions within the group, validate pillars of the program (work packages) and within these pillars refine more specifically questions deserving to be assessed.
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