University Hospital of Brussels, Free University of Brussels, Brussels.
ZNA Middelheim Hospital, Antwerp.
Eur J Cancer Prev. 2023 Mar 1;32(2):163-170. doi: 10.1097/CEJ.0000000000000770. Epub 2022 Sep 12.
The aim of the study was to describe trends in cervical cancer screening and outcomes for women under 25 years of age in Belgium between 2010 and 2019 in response to a changed reimbursement policy.
We used the databases of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Cancer Registry (BCR) for a nationwide description of cervical screening, subsequent diagnostic procedures and outcomes for women younger than 20 years and women aged 20-25 years between 2010 and 2019.
Over a 10-year period, the number of cytology screening tests and annual screening rates in women younger than 25 years have been reduced by 50%, but no increases in invasive cervical cancer or high-grade intraepithelial lesion diagnoses were observed. The major determinant of this decreased overscreening has been the limitation of reimbursement in 2013 to once every 3 years instead of once every 2 years. In women aged 25-29 years, there is no increase in invasive cervical cancer diagnoses after decreased screening of women younger than 25 years. To detect 29 invasive cervical cancers in women younger than 25 during the 10-year study period, a total of 5606 conizations were performed and 43 million EUR of Belgian health insurance budget was spent. Since the cost of hospitalization, sickness leave and negative psychological impact were not included in our estimation, these costs are underestimated.
Incidence of cervical cancer in women under 25 years remains low and screening is not effective in preventing cervical cancer, although there is clear evidence of potential reproductive harm and financial cost. We state that restricting reimbursement of cervical cancer screening before the age of 25 will improve guideline adherence and decrease healthcare expenditures without negatively impacting the health of the population.
本研究旨在描述 2010 年至 2019 年期间，比利时 25 岁以下女性宫颈癌筛查及结局的变化趋势，原因是报销政策发生了变化。
我们使用国家健康保险协会（RIZIV/INAMI）和比利时癌症登记处（BCR）的数据库，对 2010 年至 2019 年间，20 岁以下和 20-25 岁女性的宫颈筛查、后续诊断程序和结局进行了全国性描述。
在 10 年期间，25 岁以下女性的细胞学筛查检测数量和年度筛查率减少了 50%，但未观察到浸润性宫颈癌或高级别上皮内瘤变的诊断增加。这种过度筛查减少的主要决定因素是 2013 年将报销限制为每 3 年而不是每 2 年一次。在 25-29 岁的女性中，在 25 岁以下女性筛查减少后，浸润性宫颈癌的诊断并未增加。为了在 10 年的研究期间发现 29 例 25 岁以下女性的浸润性宫颈癌，共进行了 5606 例锥切术，花费了 4300 万欧元的比利时医保预算。由于我们的估计未包括住院费用、病假和负面心理影响，因此这些成本被低估了。
25 岁以下女性的宫颈癌发病率仍然较低，尽管有明确的潜在生殖危害和经济成本证据，但筛查并不能有效预防宫颈癌。我们认为，限制 25 岁以下女性的宫颈癌筛查报销将改善指南的依从性，并减少医疗保健支出，而不会对人群健康产生负面影响。
