Cervical screening in Denmark–a success followed by stagnation
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Cervical screening in Denmark–a success followed by stagnation. / Lynge, Elsebeth; Andersen, Berit; Christensen, Jette; Ejersbo, Dorthe; Jochumsen, Kirsten; Johansen, Tonje; Kristensen, Jette Kolding; Larsen, Lise Grupe; Mehnert, Frank; Mikkelsen, Ellen; Nielsen, Karsten; Rygaard, Carsten; Serizawa, Reza; Waldstrøm, Marianne.
In: Acta Oncologica, Vol. 57, No. 3, 04.03.2018, p. 354-361.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Cervical screening in Denmark–a success followed by stagnation
AU - Lynge, Elsebeth
AU - Andersen, Berit
AU - Christensen, Jette
AU - Ejersbo, Dorthe
AU - Jochumsen, Kirsten
AU - Johansen, Tonje
AU - Kristensen, Jette Kolding
AU - Larsen, Lise Grupe
AU - Mehnert, Frank
AU - Mikkelsen, Ellen
AU - Nielsen, Karsten
AU - Rygaard, Carsten
AU - Serizawa, Reza
AU - Waldstrøm, Marianne
PY - 2018/3/4
Y1 - 2018/3/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85028529479&partnerID=8YFLogxK
U2 - 10.1080/0284186X.2017.1355110
DO - 10.1080/0284186X.2017.1355110
M3 - Journal article
C2 - 28835155
AN - SCOPUS:85028529479
VL - 57
SP - 354
EP - 361
JO - Acta Oncologica
JF - Acta Oncologica
SN - 1100-1704
IS - 3
ER -
ID: 192050787