OC 14-02CERVICAL CANCER MORTALITY IN UN(DER)SCREENED WOMEN IN THE NETHERLANDS

02. Epidemiology and natural history
S. Naber 1, K. Rozemeijer 1, S. Matthijsse 1, E. Jansen 1, H. Van Agt 1, L. Overbeek 2, A. Siebers 2, F. Van Kemenade 3, M. Van Ballegooijen 4, I. De Kok 4.
11) Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Netherlands), 22) PALGA, the Nationwide network and registry of histo- and cytopathology in the Netherlands, Houten, the Netherlands (Netherlands), 33) Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Netherlands), 41) Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Netherlands)

Background / Objectives

In the Netherlands, five-year screening coverage is approximately 75%. A significant proportion of cervical cancer cases are diagnosed in women who recently refused or delayed screening participation. By examining the screening history of women who died from cervical cancer, we investigated whether the same is true for cervical cancer mortality.


Methods

Individual screening histories from the Dutch nationwide registry of histo- and cytopathology (PALGA) were linked to mortality data from the Netherlands Cancer Registry. All cervical cancer deaths between January 1996 and October 2009 were selected. Based on birth year and age, we derived whether women were recently (i.e. ≤7 years), not recently (i.e. >7 years) or never invited for screening. Screening histories were used to examine whether women were actually screened.


Results

From the 2,889 women who died from cervical cancer, 814 (28.2%) were considered never invited for screening as they were born before 1925 and were over 53 years of age in 1978, when a nationwide screening program was introduced in the Netherlands. Another 81 (2.8%) deaths from cervical cancer could not have been prevented by screening because these women were diagnosed either before  or during the year in which they were first invited for screening (2.0% and 0.8%, respectively). Another 396 women were not recently invited for screening because of their age (>67 years). From the 1,598 (55.3%) women who were diagnosed in the screening age range (31-67 years), 606 (21.0%) were recently screened, 226 (7.8%) were not recently screened, and 766 (26.5%) were never-screened.


Conclusion

From the women who were diagnosed with cervical cancer within the screening age range, 62% were not screened within the last 7 years. As in general only 25% of women are not recently screened, cervical cancer mortality risk was approximately 5 times ((0.62/0.25)/(0.38/0.75)) higher in women who did not (fully) comply with screening guidelines than in those who did. Increased awareness of this elevated mortality risk among non-participating women might increase their willingness to participate in screening.


References