Cervical screening in Denmark–a success followed by stagnation

Elsebeth Lynge; Berit Andersen; Jette Christensen; Dorthe Ejersbo; Kirsten Jochumsen; Tonje Johansen; Jette Kolding Kristensen; Lise Grupe Larsen; Frank Mehnert; Ellen Mikkelsen; Karsten Nielsen; Carsten Rygaard; Reza Serizawa; Marianne Waldstrøm

doi:10.1080/0284186x.2017.1355110

Cervical screening in Denmark–a success followed by stagnation

Elsebeth Lynge^*, Berit Andersen, Jette Christensen, Dorthe Ejersbo, Kirsten Jochumsen, Tonje Johansen, Jette Kolding Kristensen, Lise Grupe Larsen, Frank Mehnert, Ellen Mikkelsen, Karsten Nielsen, Carsten Rygaard, Reza Serizawa, Marianne Waldstrøm

^*Corresponding author for this work

17 Citations (Scopus)

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.

Original language	English
Journal	Acta Oncologica
Volume	57
Issue number	3
Pages (from-to)	354-361
Number of pages	8
ISSN	0284-186X
DOIs	https://doi.org/10.1080/0284186x.2017.1355110
Publication status	Published - 4 Mar 2018

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title = "Cervical screening in Denmark–a success followed by stagnation",

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.",

author = "Elsebeth Lynge and Berit Andersen and Jette Christensen and Dorthe Ejersbo and Kirsten Jochumsen and Tonje Johansen and Kristensen, {Jette Kolding} and Larsen, {Lise Grupe} and Frank Mehnert and Ellen Mikkelsen and Karsten Nielsen and Carsten Rygaard and Reza Serizawa and Marianne Waldstr{\o}m",

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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

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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.

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JO - Acta Oncologica, Supplement

JF - Acta Oncologica, Supplement

IS - 3

ER -

Cervical screening in Denmark–a success followed by stagnation

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