In Belgium, in 2012, cervical cancer (CC) screening was still opportunistic. We estimated the proportion of women aged 25 to 64 who participated in CC screening in 2006-2012 using individual health insurance data.
Data were provided by the Intermutualistic Agency (IMA), that compiled a database including all reimbursement records for screening Pap smears performed in Belgium between 2006 and 2012. Coverage was defined as the proportion of women from the target population who had a Pap smear taken within the last 3 years. Overuse was defined as the proportion of Pap smears taken that does not contribute to the coverage: (number of smears taken in 3 years /number of women screened in that period – 1)*100.
Until July 2009, reimbursement was not conditioned neither by age nor by screening interval, as recommended in European or Belgian guidelines (1 Pap/3 years in age group 25-64). Since July 2009, reimbursement was restricted to one Pap smear per two years.
From 2006 to 2012, the coverage dropped from 58.7% to 53.7%. Overuse decreased from 80.5% in 2006, to 18.3%, in 2012.
In the age group 25-44, the coverage varied between 59.1% and 63.6%. The coverage dropped progressively by age (to 35.9% at age 60-64) and was lower among socially vulnerable groups benefiting from increased reimbursement: 41.6% versus 55.7% among other women. 91% of Pap smears were taken by gynaecologists and 9% by general practitioners.
CC screening coverage in Belgium is moderate and tended to decrease over recent years. Restriction of reimbursement diminished over-use. Organised measures are needed to optimise coverage over all levels of the target population.