Abstract
BackgroundSystematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer. However, even in systematic screening programs, many women are still tested opportunistically. This study aimed to determine the spread of opportunistic testing in a systematic cervical cancer screening program, the impact of opportunistic testing in terms of detecting cytological abnormalities and examine the associations between sociodemography and opportunistic testing.MethodsA nationwide registry study was undertaken including women aged 23–49 years (n = 807,624) with a cervical cytology between 2010 and 2013. The women were categorised into: 1) screening after invitation; 2) routine opportunistic testing, if they were either tested more than 9 months after the latest invitation or between 2.5 years and 3 years after the latest cervical cytology and 3) sporadic opportunistic testing, if they were tested less than 2.5 years after the latest cervical cytology. Cytological diagnoses of women in each of the categories were identified and prevalence proportion differences (PPD) and 95 % confidence intervals (CIs) were used to explore group differences. Associations between sociodemography and undergoing opportunistic testing were established by multinomial logistic regression.ResultsIn total, 28.8 % of the cervical cytologies were due to either routine (20.7 %) or sporadic (8.1 %) opportunistic testing. Among women undergoing routine opportunistic testing, a larger proportion had high-grade squamous intraepithelial abnormalities than invited women (PPD: 0.6 %, 95 % CI: 0.03–1.17 %). A similar proportion of cytological abnormalities among women undergoing sporadic opportunistic testing and invited women was found. In multivariate analyses, younger age, being single or a social welfare recipient and residence region (North Denmark) were especially associated with opportunistic testing (routine or sporadic).ConclusionsOne fourth of cervical cytologies in this study were collected opportunistically. Compared to invited women, women undergoing routine opportunistic testing were more likely to be diagnosed with abnormal cytologies. Hence, routine opportunistic testing might serve as an important supplement to the systematic screening program by covering non-participating women who may otherwise be tested with a delay or not tested at all. Among women tested more often than recommended (sporadic testing), no benefits in terms of detecting more cytological abnormalities were identified.
Highlights
Systematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer
We identified the date of the last invitation, date of sample acquisition, and date of the latest cytology taken before the index cytology
Main findings We found that 28.8 % of the cervical cytology was either the result of routine (20.7 %) or sporadic opportunistic testing (8.1 %)
Summary
Systematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer. A nationally organised cervical cancer screening program is an important intervention for preventing cervical cancer Such programs target detection of precancerous cervical lesions so that women can be preventively treated and avoid developing cancer, and their use has been followed by a decrease in incidence and mortality rates of cervical cancer in many European countries [1,2,3,4]. Women who are underserved or of lower socioeconomic status tend not to participate in cervical cancer screening programs [16], which further reduces the effect of the programs because this population is at higher risk of developing cervical cancer [17]
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