Cervical Cancer Screening, Human Papillomavirus Vaccination Practices and Current Infrastructure in Israel

• In Israel every citizen is insured by one of 4 Health Maintenance Organizations.
• Screening is opportunistic, Pap recommended from 25 to 65 years every 3 years, free of charge from 35 to 54 years old.
• Between 15.1 and 36% of women attending the two largest HMOs in Israel were screened.
• Screening discrepancies exist between high SES 33–37% and low SES regions 10–16%.
• HPV vaccination will be introduced to the school-based vaccine program during 2013.

The incidence rates for premalignant lesions in Jewish women in Israel are similar to those observed in Western countries, but the incidence of cervical cancer in Israel is low; this discrepancy is not yet clearly understood. Because of the low incidence of cervical cancer in Israel, it was decided to base cervical cancer prevention on opportunistic screening: every woman from the ages of 35–54 years can have a Pap test smear free of charge every 3 years. Over the last decade 12.2% of the women population had an annual Pap test. From 36 to 50% of women who attended the Clalit Health Maintenance Organization (HMO) and the Maccabi HMO, the two largest HMOs in Israel, did so. There were also discrepancies between women of different socio-economic status (SES): <10% in the lowest SES level were screened compared to almost 55% in the higher level. HPV vaccination was opportunistic but it will be introduced to the school-based vaccine program at age of 13 years old as of September 2013. The Israel Society of Obstetrics and Gynecology recommends continuing cytologic screening in vaccinated women as recommended for the general population.This article forms part of a regional report entitled “Comprehensive Control of HPV Infections and Related Diseases in Israel” Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.