Attendance at Cervical Cancer Screening and Use of Diagnostic and Therapeutic Procedures on the Uterine Cervix Assessed from Individual Health Insurance Data (Belgium, 2002-2006)

Abstract

ObjectiveTo assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.MethodsThe Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years.ResultsCervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively.ConclusionThe screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.

Human Papillomavirus Positivity in Women Undergoing Intrauterine Insemination Has a Negative Effect on Pregnancy Rates

“…HPV data were only available for 60% of the women participating in the IUI program. This is in agreement with the Belgian screening coverage of 60% [28]. In the current study, 10.0% of the women undergoing IUI tested positive for HPV.…”

The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines

“…Very recent findings from Finland indicate that carefully managed invitation/reminder letters with scheduled appointments and self-sampling options offered to non-attending women can increase organised programme effectiveness [41]. On the other hand, Belgian experience shows that sending invitations hardly influences screening coverage in a country with a long tradition of opportunistic screening [42]. Appropriate trials run in the real-life conditions are required to demonstrate the effectiveness of actions planned in Poland to increase organised screening coverage before costly implementation.…”

“…No reimbursement for opportunistic smears could reduce overscreening in some cohorts, promote screening at recommended intervals and drive shifts towards organised screening [42]. However, stopping reimbursement of opportunistic screening might be controversial both for women and most of gynaecologists in Poland in the initial years.…”

Lifestyle and health-related predictors of cervical cancer screening attendance in a Swiss population-based study

“…Participation rates vary depending on type of screening program (opportunistic or organized) and local CC screening recommendations. Participation rates amounted to 61% in Belgium (Arbyn et al, 2014), 86.6% in Norway (Hansen et al, 2011), between 78.5% and 83.5% in England (Bang et al, 2012), and 70% in Austria (Breitenecker, 2009).…”