UICC World Cancer Congress 2006

Objective: Screening performance relies on quality and efficiency of protocols and guidelines for screening and follow-up. Evidence of low attendance rates, over-screening of young women and low smear specificity gathered by the early 1990's in the Dutch cervical cancer screening program called for an improvement. Several protocols and guidelines were redefined in 1996, with emphasis on assuring that these would be adhered to. We assessed improvement since 1996 by changes in various indicators: coverage rates, follow-up compliance and number of smears.

Methods: Information on all cervix uteri tests in the Netherlands registered until 31st March 2004 was retrieved from the nationwide registry of histo- and cytopathology (PALGA).

Results: After broadening of the target age group in 1996 (from 35-53 to 30-60 years) and the introduction of systematic personal invitations and reminders, five-year coverage rates in the added age groups increased close to those observed among the 35-53 year-old women (80%). More restrictive definitions in the Pap 2 classification and cessation of follow-up of negative smears lacking endocervical cells caused a decrease in screened women in follow-up from 19% to 3%. With new follow-up guidelines, 14% more women with abnormal smears were followed-up, and the time spent in follow-up has decreased. Ceasing to reimburse non-program screening smears led to a sharp decline in such smears. These changes led to a 20% decrease in the annual number of smears made, especially among young women. It is too early to assess the long-term impact of changes on interval cancer rates.