denmark
DESCRIPTION
What happens when organisation of cervical cancer screening is delayed or stopped? Elsebeth Lynge [email protected]. DENMARK. Opportunistic screening, 1969: All smears paid by the national health insurance National guidelines for organisation, 1986: Target age group: 23–59 years - PowerPoint PPT PresentationTRANSCRIPT
What happens when organisation of
cervical cancer screeningis delayed or stopped?
Elsebeth [email protected]
DENMARKOpportunistic screening, 1969:• All smears paid by the national health insurance
National guidelines for organisation, 1986:• Target age group: 23–59 years• Screening interval: 3 years• Smear takers: general practitioners• Registration of all smears (in pathology/health
insurance data)• Only invitation to women without a smear during the
last 3 years
Copenhagen MFrederiksberg
Copenhagen CFrederiksborg
RoskildeVestsjælland
StorstrømBornholm
FynSønderjylland
RibeVejle
RingkøbingÅrhusViborg
NordjyllandOpportunistic
1960 1970 1980 1990 2000
INTRODUCTION OF ORGANISED CERVICAL CANCER SCREENING
COVERAGE late 1980s
T
y
p
e
County Age group
15-22
23-30
30-50
50-60
Org Bornholm 23% 83% 88% 59%
Opp Vestsjælland 53% 83% 69% 38%
Org Storstrøm 21% 54% 91% 22%
Opp Storstrøm 57% 82% 66% 33%
COVERAGE late 1980s
T
y
p
e
County Age group
15-22
23-30
30-50
50-60
Org Bornholm 23% 83% 88% 59%
Opp Vestsjælland 53% 83% 69% 38%
Org Storstrøm 21% 54% 91% 22%
Opp Storstrøm 57% 82% 66% 33%
COVERAGE late 1980s
T
y
p
e
County Age group
15-22
23-30
30-50
50-60
Org Bornholm 23% 83% 88% 59%
Opp Vestsjælland 53% 83% 69% 38%
Org Storstrøm 21% 54% 91% 22%
Opp Storstrøm 57% 82% 66% 33%
Copenhagen MFrederiksberg
Copenhagen CFrederiksborg
RoskildeVestsjælland
StorstrømBornholm
FynSønderjylland
RibeVejle
RingkøbingÅrhusViborg
NordjyllandOpportunistic
1960 1970 1980 1990 2000
INTRODUCTION OF ORGANISED CERVICAL CANCER SCREENING
1973 1978 1983 1988 1993 1998 20030
0,5
1
1,5
2Cumulative rate per 100
Early starting counties
Late starting counties
Incidence
Mortality
DenmarkCumulative rate per 100 of cervical cancer for women aged 30 to 64
TREND ANALYSIS
Poisson regression analysis,
Interaction term between
type of county and calender period:
Incidence p = 0.0151
Mortality p = 0.9593
Copenhagen MFrederiksberg
Copenhagen CFrederiksborg
RoskildeVestsjælland
StorstrømBornholm
FynSønderjylland
RibeVejle
RingkøbingÅrhusViborg
NordjyllandOpportunistic
1960 1970 1980 1990 2000
INTRODUCTION OF ORGANISED CERVICAL CANCER SCREENING
1973 1978 1983 1988 1993 1998 20030
0,5
1
1,5
2Cumulative rate per 100
Period withoutorganised
screening inStorstrøm
county
Incidence
Mortality
Continued programmes
Storstrøm county
DenmarkCumulative rate per 100 of cervical cancer for women aged 30 to 64
ANALYSIS OF PEAK
Poisson regression analysis
for period 1993–97:
Incidence 1.31 (95% CI 1.05–1.62)
Mortality 1.50 (95% CI 1.02–2.22)
CONCLUSION
• Organisation of cervical cancer screening accelerated the decline in cervical cancer incidence.
• A decade-long stop of an organised programme was associated with a temporary increase in cervical cancer incidence and mortality.