Abstract
ObjectiveTo assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.MethodsThe Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years.ResultsCervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively.ConclusionThe screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.
Highlights
For the year 2010, 593 new cases of cervical cancer (World-age standardised rate (W-ASR) 7.5/100,000 women-years) were reported by the Belgian Cancer Registry [www.kankerregister. org/], and the most recent estimates for 2008 showed that approximately 275 women (W-ASR 2.7/100,000 women-years) died from the disease [1,2]
In Belgium, screening remained essentially opportunistic, which means that Pap smears are taken at the spontaneous initiative of the woman, her gynaecologist or her general practitioner [11,12]
The Belgian cervical cancer screening policy is adapted from European Guidelines and foresees one Pap smear or liquid-based cytology sample every three years for women of 25 to 64 years of age [14,15,16]
Summary
For the year 2010, 593 new cases of cervical cancer (World-age standardised rate (W-ASR) 7.5/100,000 women-years) were reported by the Belgian Cancer Registry [www.kankerregister. org/], and the most recent estimates for 2008 showed that approximately 275 women (W-ASR 2.7/100,000 women-years) died from the disease [1,2]. For the year 2010, 593 new cases of cervical cancer (World-age standardised rate (W-ASR) 7.5/100,000 women-years) were reported by the Belgian Cancer Registry [www.kankerregister. Through wellorganised cytological screening of high quality, the incidence of cervical cancer can be reduced substantially [5,6,7,8,9,10]. Opportunistic screening often results in a high level of overscreening and a heterogeneous quality[13]. The Belgian cervical cancer screening policy is adapted from European Guidelines and foresees one Pap smear or liquid-based cytology sample every three years for women of 25 to 64 years of age [14,15,16]. The level of adherence to this policy is rather poor, in the Flemish provinces where in the mid-1990s, a program was set up involving invitation of women in the target age range 25-64 [11,12]
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