Elsebeth Lynge1, Berit Andersen2, Jette Christensen3, Dorthe Ejersbo4, Kirsten Jochumsen5, Tonje Johansen6, Jette Kolding Kristensen7, Lise Grupe Larsen8, Frank Mehnert9, Ellen Mikkelsen9, Karsten Nielsen10, Carsten Rygaard11, Reza Serizawa11, Marianne Waldstrøm4,12. 1. a Department of Public Health , University of Copenhagen , København K , Denmark. 2. b Department of Public Health Programmes , Randers Regional Hospital , Randers NØ , Denmark. 3. c Department of Pathology , Aalborg University Hospital , Aalborg , Denmark. 4. d Department of Pathology , Lillebælt Hospital , Vejle , Denmark. 5. e Department of Gynaecology and Obstectrics , Odense University Hospital , Odense C , Denmark. 6. f Department of Pathology , Randers Regional Hospital , Randers NØ , Denmark. 7. g Research Unit of General Practice and Department of Clinical Medicine , Aalborg University , Aalborg , Denmark. 8. h Department of Surgical Pathology , Zealand University Hospital , Roskilde , Denmark. 9. i Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus N , Denmark. 10. j Pathology Department , Aarhus University Hospital , Aarhus C , Denmark. 11. k Pathology Department , Copenhagen University Hospital , Hvidovre , Denmark. 12. l Institute of Regional Health Research , University of Southern Denmark , Odense M , Denmark.
Abstract
INTRODUCTION: Despite an intensive screening activity, the incidence of cervical cancer in Denmark has remained stable for the last 15 years, while regional differences have increased. To search for explanations, we investigated possible weaknesses in the screening program. MATERIAL AND METHODS: Data on the screen-targeted women were retrieved from Statistics Denmark. Data on screening activity were retrieved from the annual reports from 2009 to 2015 on quality of cervical screening. Coverage was calculated as proportion of screen-targeted women with at least one cytology sample within recommended time intervals. Insufficient follow-up was calculated as proportion of abnormal and unsatisfactory samples not followed up within recommended time intervals. Diagnostic distribution was calculated for samples with a satisfactory cytology diagnosis. RESULTS: Coverage remained stable at 75%-76% during the study period. Annually, approximately 100,000 women are screened before they are eligible for invitation, and 600,000 invitations and reminders are issued resulting in screening of 200,000 women. In 2009, 21% of abnormal and unsatisfactory samples were not followed up within the recommended time interval; a proportion that had decreased to 15% in 2015. Overall, 11% of satisfactory samples with a cytology diagnosis were abnormal, but with surprising variation from 6% to 15% across regions. DISCUSSION: The success of a screening program depends first of all on coverage and timely follow-up of abnormal findings. Our analysis indicated that the currently high incidence of cervical cancer in Denmark may partly be due to low screening coverage. Also worrisome is a high proportion of non-timely follow-up of abnormal findings. Innovative ways to improve coverage and follow-up are urgently needed.
INTRODUCTION: Despite an intensive screening activity, the incidence of cervical cancer in Denmark has remained stable for the last 15 years, while regional differences have increased. To search for explanations, we investigated possible weaknesses in the screening program. MATERIAL AND METHODS: Data on the screen-targeted women were retrieved from Statistics Denmark. Data on screening activity were retrieved from the annual reports from 2009 to 2015 on quality of cervical screening. Coverage was calculated as proportion of screen-targeted women with at least one cytology sample within recommended time intervals. Insufficient follow-up was calculated as proportion of abnormal and unsatisfactory samples not followed up within recommended time intervals. Diagnostic distribution was calculated for samples with a satisfactory cytology diagnosis. RESULTS: Coverage remained stable at 75%-76% during the study period. Annually, approximately 100,000 women are screened before they are eligible for invitation, and 600,000 invitations and reminders are issued resulting in screening of 200,000 women. In 2009, 21% of abnormal and unsatisfactory samples were not followed up within the recommended time interval; a proportion that had decreased to 15% in 2015. Overall, 11% of satisfactory samples with a cytology diagnosis were abnormal, but with surprising variation from 6% to 15% across regions. DISCUSSION: The success of a screening program depends first of all on coverage and timely follow-up of abnormal findings. Our analysis indicated that the currently high incidence of cervical cancer in Denmark may partly be due to low screening coverage. Also worrisome is a high proportion of non-timely follow-up of abnormal findings. Innovative ways to improve coverage and follow-up are urgently needed.
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