The nationwide screening program for cervical carcinoma in The Netherlands was unique in that all women between the age of 35 and 55 years were individually invited to undergo a cervical spatula smear. The total rate of positive histologic findings in six regions of the country was 3.9 per thousand, and decreased in the second screening after 3 years with 48% of patients. Further analysis of the change in rates of the separate histologic subgroups in six regions revealed: Severe dysplasia showed no change in rates. The rates of carcinoma in situ and invasive squamous cell carcinoma were influenced clearly by the screening. The preinvasive stages of adenocarcinoma of the cervix were underdiagnosed in the first screening, and there was no decrease in the score of invasive adenocarcinoma. The rates in the six regions differed significantly and were dependent on the degree of urbanization. Cervical screening using the Ayre spatula is not effective for detecting cervical adenocarcinomas.

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The effect of regular 3-yearly screening over a period of 12 years, on the incidence of cervical cancer in 25,000 women aged 35-54 years, is examined. The rate of squamous cell carcinoma decreased from 0.38 per 1000 women in the first round to zero in the fourth round. Similarly, the rate of carcinoma in situ declined from 1.69 per 1000 women in the first round to 0.35 per 1000 in the fourth round. The rates of severe dysplasia showed no decline. Cytologic under diagnosis of carcinoma-in-situ and cervical carcinoma increased with each round. Widowed and divorced women and those living in urban areas were identified as high risk groups.