Long-term adherence to follow-up after treatment of cervical intraepithelial neoplasia: nationwide population-based study

TY - JOUR

T1 - Long-term adherence to follow-up after treatment of cervical intraepithelial neoplasia

T2 - nationwide population-based study

AU - Barken, Sidsel S

AU - Lynge, Elsebeth

AU - Andersen, Erik S.

AU - Rebolj, Matejka

N1 - © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2013/7

Y1 - 2013/7

N2 - OBJECTIVE: To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia. DESIGN: Prospective, population-based, register study. SETTING: Denmark, 1996-2007. POPULATION: All women treated for cervical intraepithelial neoplasia with conization. METHODS: Treated women were routinely recommended to have follow-up with annual smears for at least 5 years. MAIN OUTCOME MEASURES: Using individually linked nationwide register data on conizations and follow-up tests (smears and biopsies), we calculated the cumulative proportion of treated women undergoing the recommended follow-up. We measured this cumulative proportion conservatively in 15-month intervals for 5 years. RESULTS: Adherence to annual follow-up among 45 984 treated women decreased gradually. In total, 90% of these women obtained at least one smear in the first post-treatment year, but only 40% obtained the recommended tests for 5 years. Five-year adherence was substantially better outside the capital area, for example, the odds ratio for women from Jutland compared with women from the capital area was 1.70 (95% confidence interval 1.60-1.82). CONCLUSIONS: Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.

AB - OBJECTIVE: To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia. DESIGN: Prospective, population-based, register study. SETTING: Denmark, 1996-2007. POPULATION: All women treated for cervical intraepithelial neoplasia with conization. METHODS: Treated women were routinely recommended to have follow-up with annual smears for at least 5 years. MAIN OUTCOME MEASURES: Using individually linked nationwide register data on conizations and follow-up tests (smears and biopsies), we calculated the cumulative proportion of treated women undergoing the recommended follow-up. We measured this cumulative proportion conservatively in 15-month intervals for 5 years. RESULTS: Adherence to annual follow-up among 45 984 treated women decreased gradually. In total, 90% of these women obtained at least one smear in the first post-treatment year, but only 40% obtained the recommended tests for 5 years. Five-year adherence was substantially better outside the capital area, for example, the odds ratio for women from Jutland compared with women from the capital area was 1.70 (95% confidence interval 1.60-1.82). CONCLUSIONS: Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.

U2 - 10.1111/aogs.12116

DO - 10.1111/aogs.12116

M3 - Journal article

C2 - 23418941

SN - 0001-6349

VL - 92

SP - 852

EP - 857

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 7

ER -