Cervical cancer screening in Belgium.

A description is given of the burden of cervical cancer and the status of screening in Belgium until 1998. Screening is essentially opportunistic and generally performed at yearly intervals. A programme for organised screening - promoting one cervical smear every 3 years for women aged between 25 and 64 years - is being set up in the Flemish Region alone. Important progress has been made concerning the development of technical guidelines on the collection of an adequate Papanicolaou (Pap) smear, uniform terminology for the cytological report and the follow-up of positive tests. The implementation of the programme is confined to the provinces that are instructed to make women and physicians aware of the screening policy. The establishment of a screening register, allowing for individualised invitation of women, was hampered by strict privacy laws and by the heterogeneity of software used for data entry in cytological laboratories. The impact of the Flemish programme was further limited since the reimbursement of smear taking by a gynaecologist or a general practitioner (GP) and the cytological reading are not conditioned by the respect of guidelines. This is due to the fact that the organisation of preventive healthcare and the financing of medical activities concerns distinct authorities. The coverage of the target population is good in Flanders (82.3% according to certain estimates), but is achieved at the expense of an important amount of over-screening. The coverage is lower in the Walloon and the Capital Region. Rationalisation of the policy regarding cancer screening involving all concerned authorities of the country is necessary.