Department of Sociology, Ghent University, Ghent, Belgium.
Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Geneva, Switzerland.
Eur J Public Health. 2020 Jun 1;30(3):410-415. doi: 10.1093/eurpub/ckaa041.
Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25-64, Switzerland: 20-70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries.
Data from five waves of the Belgian Health Interview Survey (1997-2013) (N=11 141) and Swiss Health Interview Survey (1992-2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range.
CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives.
Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.
巴氏涂片宫颈筛查（Pap 涂片）的应用降低了宫颈癌的发病率和死亡率。在没有组织项目的情况下，比利时和瑞士的宫颈筛查是机会性的。这可能导致宫颈筛查过度使用，因为筛查实践不符合建议的每 3 年筛查间隔和目标年龄范围（比利时：25-64 岁，瑞士：20-70 岁）。本研究旨在评估比利时和瑞士宫颈筛查的利用率和过度使用率的趋势及其社会决定因素，鉴于这两个国家都实施了报销倡议。
使用了五次比利时健康访谈调查（1997-2013 年）（N=11141）和瑞士健康访谈调查（1992-2012 年）（N=32696）的数据。我们使用泊松回归来估计调整后的流行率比（APR），控制了社会经济和社会人口统计学特征以及健康状况。将筛查超过每 3 年一次和筛查超过推荐年龄范围定义为宫颈筛查过度使用。
宫颈筛查利用率随着时间的推移保持相对稳定，比利时的平均覆盖率为 70.9%，瑞士为 73.1%。两国都存在教育和收入梯度。关于宫颈筛查过度使用，超过筛查年龄的女性始终保持较高的筛查率，但两国在过去一年中的筛查率均显著下降，与报销倡议的实施时间相匹配。
尽管没有增加宫颈筛查的覆盖率，但由于实施了针对宫颈筛查过度使用的报销措施，人群水平的巴氏涂片过度使用有所减少，两国的宫颈筛查变得更加有效。
