Increased burden of treatment of cervical intraepithelial neoplasia: Denmark 1991 to 2007

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Introduction: Since the introduction of cytological screening in Denmark in the late 1960s, the incidence of cervical cancer decreased from 40 to 14 per 100,000 due to treatment of screen-detected cervical intraepithelial neoplasia (CIN). However, some overtreatment is inevitable and its side-effects a major concern. As the frequency of treatment may increase in the future due to a change from cytology- to HPVDNA-based screening, we studied the trends in the burden of CIN treatments since 1991, in the period while screening was cytology-based.
Methods: We retrieved virtually complete data on conisations, destructive therapies, excisions, hysterectomies and cervical treatments NOS from: The Pathology, Hospital Discharge, Health Insurance and Danish Cancer Register, for all female Danish residents aged 15 to 84 between 1991 and 2007. After linking the data using the unique Danish identification numbers, we excluded all duplicates and all destructive therapies and hysterectomies for which no cervical diagnosis was found in the period around the treatment. The total number of treatments was age-standardized using the Danish female population in 2007 as the standard population.
Results: The preliminary results show that the total burden of treatments increased by about 36,3 % between 1991 and 2007 (Figure 1). There is however some uncertainty regarding destructive treatments due to CIN, but even using a maximum estimate we still observed an increase of 15,7% in the total burden of treatments in the same period.
Conclusion: In Denmark, the total burden of treatment for CIN with cytology-based screening increased since 1991 by 15,7 % to 36,3%. If HPV DNA-screening is introduced in the future, much emphasis will need to be given to balancing any further increases in CIN treatments.

Figure 1: Total numbers of CIN treatments (conisations, excisions, cervical treatments NOS, hysterectomies and destructive therapies attributed to CIN) in Denmark, 1991-2007.

Original languageEnglish
Publication date5 Jul 2011
Publication statusPublished - 5 Jul 2011

ID: 34482203