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Cervical screening in Denmark – a success followed by stagnation

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  • Elsebeth Lynge, University of Copenhagen
  • ,
  • Berit Andersen
  • Jette Christensen, Aalborg University
  • ,
  • Dorthe Ejersbo, Department of Pathology, Lillebælt Hospital, Vejle
  • ,
  • Kirsten Jochumsen, Odense Universitetshospital
  • ,
  • Tonje Johansen
  • ,
  • Jette Kolding Kristensen, Research Unit of General Practice and Department of Clinical Medicine
  • ,
  • Lise Grupe Larsen, Department of Surgical Pathology, Zealand University Hospital, Roskilde
  • ,
  • Frank Mehnert
  • Ellen Mikkelsen
  • Karsten Nielsen
  • ,
  • Carsten Rygaard, University of Copenhagen
  • ,
  • Reza Serizawa, University of Copenhagen
  • ,
  • Marianne Waldstrøm, Lillebaelt Hospital, University of Southern Denmark

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 languageEnglish
JournalActa Oncologica
Volume57
Issue3
Pages (from-to)354-361
Number of pages8
ISSN0284-186X
DOIs
Publication statusPublished - 4 Mar 2018

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