Cervical cancer remains a major public health challenge, with significant social inequalities in incidence, mortality, and screening follow-up, even in high-income countries like Belgium. Despite the introduction of an organized screening program in Flanders in 2013, the follow-up rate for abnormal Pap smears remains below the WHO’s 90% target, particularly among socioeconomically disadvantaged women. The existing fail-safe system, implemented in 2018, aims to improve follow-up rates but its impact on social inequalities remains unclear. 

This PhD research, part of an FWO project within the "Kom op tegen Kanker" call, aims to: (1) assess social inequalities in the timely follow-up of abnormal screening results in Flanders, (2) evaluate the effectiveness of the fail-safe mechanism in addressing these inequalities, and (3) develop and pilot-test an intervention in co-creation with the target population to improve timely follow-up.

A retrospective population-based cohort study will analyze linked administrative data from the Belgian Cancer Registry (BCR), the Intermutualistic Agency (IMA), and Statistics Belgium (Statbel) to examine follow-up rates before and after the fail-safe system’s implementation. Additionally, qualitative research with healthcare providers will explore experiences and perspectives on factors contributing to untimely follow-up of abnormal cervical cancer screening results (WP1).

To address gaps identified in the first two research questions, an intervention will be developed in co-creation with most important stakeholders identified (e.g. women without (timely) follow-up, healthcare providers). A pilot study will assess feasibility, appropriateness, and potential effectiveness. The results will inform evidence-based strategies to improve cervical cancer screening follow-up and reduce social inequalities in cancer outcomes in Flanders (WP2).