Organization and results of cervical cancer screening in the German Democratic Republic.

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.