@article{Dong2025, 
author = {Mingjie Dong and Jiaxin Xie and Xuelian Zhao and Fanghui Zhao},
title = {Impact of government-organized screening programs on the economic burden of cervical cancer across five disease courses: a multistage regression and mediation analysis},
year = {2025},
journal = {Cancer Biology & Medicine},
volume = {22},
number = {9},
pages = {1083-1101},
keywords = {Cervical cancer, government-organized screening, economic burden, early detection},
url = {https://www.sciopen.com/article/10.20892/j.issn.2095-3941.2025.0418},
doi = {10.20892/j.issn.2095-3941.2025.0418},
abstract = {ObjectiveTo evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions, and explore mediating pathways across diagnosis, initial treatment, radiotherapy/chemotherapy, follow-up, and recurrence/progression/metastasis.MethodsA multicentre, nationwide survey across 5 disease courses was conducted from 26 hospitals in China. Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up, self-paid check-up, and symptom-based detection.ResultsWorkplace check-up, self-paid check-up, and symptom-based detection were associated with progressively higher costs across diagnosis [β: 1.10, 95% confidence interval (CI): 0.54–1.67; β: 1.46, 95% CI: 1.00–1.92; and β: 1.68, 95% CI: 1.25–2.11, respectively], initial treatment (β: 0.36, 95% CI: 0.18–0.55; β: 0.51, 95% CI: 0.35–0.66; and β: 0.56, 95% CI: 0.42–0.70, respectively), and follow-up (β: 0.63, 95% CI: 0.38–0.88; β: 0.83, 95% CI: 0.61–1.04; and β: 0.85, 95% CI: 0.65–1.06, respectively) compared to government-organized screening (all P < 0.05). Earlier clinical staging and greater use of lower-level hospitals mediated 44.74%–54.97% of cost differences in diagnosis, 73.27%–85.04% in initial treatment, and 30.38%–54.73% in follow-up. Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions.ConclusionsGovernment-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis, reduced overtreatment, and decreased reliance on higher-level hospitals, suggesting potential clinical benefits, efficient resource use, and improved equity in cancer care.}
}