Abstract

BackgroundHigh coverage of a screening program is essential to program success. Many European screening programs cover only 10–80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population.MethodsA population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986).The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy.ResultsThe coverage among women aged 26–49 years and 55–64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26–49 years) and 79.4% (55–64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes.ConclusionsExcluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women.

Highlights

  • High coverage of a screening program is essential to program success

  • The incidence has been decreasing in most European countries with the introduction of cervical cancer screening programs; a similar decrease is not seen in countries without organized screening programs, such as in Eastern Europe [2, 3]

  • In a 2-year period (1998–2000), more than 10,000 hysterectomies were performed in Denmark on benign indications [8] and between 2006 and 2011, 1.7 hysterectomies were performed per 1000 women [9]; this indicates that the prevalence of hysterectomy in the National Cervical Cancer Screening Program (NCCSP) target population may be substantial

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Summary

Introduction

Many European screening programs cover only 10–80% of their target population. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, they are not at risk of cervical cancer. Little is known about the sociodemographic characteristics of women included in the target population for cervical cancer screening who have had a total hysterectomy

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