a Department of Public Health , University of Copenhagen , København K , Denmark.
b Department of Public Health Programmes , Randers Regional Hospital , Randers NØ , Denmark.
Acta Oncol. 2018 Mar;57(3):354-361. doi: 10.1080/0284186X.2017.1355110. Epub 2017 Aug 23.
Despite an intensive screening activity, the incidence of cervical cancer in Denmark has remained stable for the last 15 years, while regional differences have increased. To search for explanations, we investigated possible weaknesses in the screening program.
Data on the screen-targeted women were retrieved from Statistics Denmark. Data on screening activity were retrieved from the annual reports from 2009 to 2015 on quality of cervical screening. Coverage was calculated as proportion of screen-targeted women with at least one cytology sample within recommended time intervals. Insufficient follow-up was calculated as proportion of abnormal and unsatisfactory samples not followed up within recommended time intervals. Diagnostic distribution was calculated for samples with a satisfactory cytology diagnosis.
Coverage remained stable at 75%-76% during the study period. Annually, approximately 100,000 women are screened before they are eligible for invitation, and 600,000 invitations and reminders are issued resulting in screening of 200,000 women. In 2009, 21% of abnormal and unsatisfactory samples were not followed up within the recommended time interval; a proportion that had decreased to 15% in 2015. Overall, 11% of satisfactory samples with a cytology diagnosis were abnormal, but with surprising variation from 6% to 15% across regions.
The success of a screening program depends first of all on coverage and timely follow-up of abnormal findings. Our analysis indicated that the currently high incidence of cervical cancer in Denmark may partly be due to low screening coverage. Also worrisome is a high proportion of non-timely follow-up of abnormal findings. Innovative ways to improve coverage and follow-up are urgently needed.
尽管丹麦进行了密集的筛查活动，但过去 15 年来，宫颈癌的发病率一直保持稳定，而地区差异却有所增加。为了寻找原因，我们调查了筛查项目中可能存在的弱点。
从丹麦统计局检索了针对筛查目标女性的相关数据。从 2009 年至 2015 年的年度报告中检索了有关宫颈筛查质量的筛查活动数据。覆盖率按在推荐时间间隔内至少接受一次细胞学检查的筛查目标女性比例计算。未及时随访的比例按未在推荐时间间隔内随访异常和不满意样本的比例计算。对细胞学诊断满意的样本计算诊断分布。
在研究期间，覆盖率一直保持在 75%-76%的稳定水平。每年约有 10 万名女性在有资格接受邀请之前接受筛查，共发出 60 万份邀请和提醒，最终有 20 万名女性接受了筛查。2009 年，有 21%的异常和不满意样本未在推荐时间间隔内得到随访；这一比例在 2015 年已降至 15%。总体而言，11%细胞学诊断满意的样本异常，但各地区的比例差异惊人，从 6%到 15%不等。
筛查项目的成功首先取决于覆盖率和对异常结果的及时随访。我们的分析表明，丹麦目前较高的宫颈癌发病率可能部分归因于较低的筛查覆盖率。异常结果的及时随访比例较高也令人担忧。迫切需要创新方法来提高覆盖率和随访率。
