Effects of streamlining cervical cancer screening the Dutch way: consequences of changes in the Dutch KOPAC-based follow-up protocol and consensus-based limitation of equivocal cytology

TY - JOUR

T1 - Effects of streamlining cervical cancer screening the Dutch way: consequences of changes in the Dutch KOPAC-based follow-up protocol and consensus-based limitation of equivocal cytology

AU - Briët, Martijn C

AU - Berger, Thomas H D

AU - van Ballegooijen, Marjolein

AU - Boon, Mathilde E.

AU - Rebolj, Matejka

PY - 2010

Y1 - 2010

N2 - Objective: To analyze the impact of the 1995 revision of the Dutch cervical screening program guidelines (e.g., the introduction of more stringent criteria for cytologic diagnosis of atypical squamous cells of undetermined significance [ASCUS]) on the negative side effects of screening in Region West. Study Design: The data for this study were retrieved as two complementary datasets, both of which contained data on the invited screenees, including their cytology and histology follow-up. One dataset additionally included data on other smears. For invited screenees, we analyzed changes in cytoscores and histoscores between 1994, the last year before new screening guidelines were implemented, and 2003, the latest year for which follow-up to screening abnormalities was available in the retrieved data. Additionally, we analyzed changes in the total number of primary and repeat smears made. Results: Between 1994 and 2003, the cytoscore for ASCUS decreased from 19.4% to 1.3% of screenee smears. The total number of smears taken decreased by 30%. The cervical intraepithelial neoplasia 3+ histoscore remained the same (OR= 0.97, p = 0.91). Conclusion: The reduction of equivocal ASCUS diagnoses resulted in a decrease of costly repeat smears, without measurably decreasing the effectiveness of the screening program.

AB - Objective: To analyze the impact of the 1995 revision of the Dutch cervical screening program guidelines (e.g., the introduction of more stringent criteria for cytologic diagnosis of atypical squamous cells of undetermined significance [ASCUS]) on the negative side effects of screening in Region West. Study Design: The data for this study were retrieved as two complementary datasets, both of which contained data on the invited screenees, including their cytology and histology follow-up. One dataset additionally included data on other smears. For invited screenees, we analyzed changes in cytoscores and histoscores between 1994, the last year before new screening guidelines were implemented, and 2003, the latest year for which follow-up to screening abnormalities was available in the retrieved data. Additionally, we analyzed changes in the total number of primary and repeat smears made. Results: Between 1994 and 2003, the cytoscore for ASCUS decreased from 19.4% to 1.3% of screenee smears. The total number of smears taken decreased by 30%. The cervical intraepithelial neoplasia 3+ histoscore remained the same (OR= 0.97, p = 0.91). Conclusion: The reduction of equivocal ASCUS diagnoses resulted in a decrease of costly repeat smears, without measurably decreasing the effectiveness of the screening program.

KW - Adenocarcinoma

KW - Cervical Intraepithelial Neoplasia

KW - Clinical Protocols

KW - Consensus Development Conferences as Topic

KW - Databases, Factual

KW - Female

KW - Follow-Up Studies

KW - Gynecology

KW - Humans

KW - Mass Screening

KW - Netherlands

KW - Pathology, Clinical

KW - Uterine Cervical Dysplasia

KW - Uterine Cervical Neoplasms

KW - Vaginal Smears

U2 - 10.1159/000325251

DO - 10.1159/000325251

M3 - Journal article

C2 - 21428155

SN - 0001-5547

VL - 54

SP - 1095

EP - 1100

JO - Acta Cytologica

JF - Acta Cytologica

IS - 6

ER -