Ebeling K, Nischan P
IARC Sci Publ. 1986(76):251-66.
This paper describes the introduction of a cervical cancer screening programme in the German Democratic Republic after conclusions were drawn from two pilot studies. The pilot studies were carried out to decide between two organizational structures: computerized monitoring, such as invitations to participate, versus full integration of the programme into the basic gynaecological health care system. Since similarly high attendance rates were obtained in the two systems, the recommendation for the GDR as a whole was to conform with the noncomputerized system. This programme has been implemented in Berlin, capital of the GDR, for ten years. Incidence decreased rapidly among women of all ages (33% lower than at the beginning) and for women aged 40-49 (58% lower). Mortality rates for women of all ages are now 37% lower, and for women of ages 50-59, 57% lower. A comparison of incidence in the screened and unscreened population shows that nonparticipants have a relative risk of 3.0 for developing the disease and of 11.3 for dying from the disease. In an analysis of the failures of screening, the cervical smears of 184 previously screened cancer cases were re-examined. In 48% no reason for failure was found. Possibilities for improving the results further, including a screening registry, are discussed.
本文介绍了在两项试点研究得出结论后，德意志民主共和国引入宫颈癌筛查计划的情况。开展试点研究是为了在两种组织结构之间做出抉择：计算机化监测，如邀请参与，以及将该计划完全融入基本妇科医疗保健系统。由于在这两种系统中获得了相似的高参与率，因此针对整个德意志民主共和国的建议是采用非计算机化系统。该计划已在德意志民主共和国首都柏林实施了十年。所有年龄段女性的发病率迅速下降（比开始时低33%），40 - 49岁女性的发病率下降了58%。所有年龄段女性的死亡率现在降低了37%，50 - 59岁女性的死亡率降低了57%。对筛查人群和未筛查人群的发病率进行比较表明，未参与者患该疾病的相对风险为3.0，死于该疾病的相对风险为11.3。在对筛查失败情况的分析中，对184例先前筛查出的癌症病例的宫颈涂片进行了重新检查。48%的病例未发现失败原因。文中还讨论了进一步改善结果的可能性，包括建立筛查登记册。
