In June 2013, the Flemish cervical cancer screening program started. Before 2013, screening was essentially opportunistic. A efficient call recall system was set up, only inviting women who are not adequately screened. The screening program motivates eligible women 25-64 y to be screened every three years, by means of a PAP smear.
The Belgian Cancer registry collects the test results of all cervical samples in a central cyto-histopathological registry and retrieves from the IMA/AIM reimbursement data of clinical acts which are relevant for the detection, monitoring and treatment of cervical cancer. Hence, the Cancer registry compiles an exclusion list that consists of all women for which a screening examination is not required for the next invitation round. Hence, the Centre of Cancer screening will exclusively invite women who are eligible for screening.
The program faces several challenges:
Coverage remains stable around 63%. 37% women are never or rarely screened. Research into the socio-demographic characteristics of non-responders demonstrated an significant social gradient. Furthermore, Eastern Europe migrant women are under screened. Targeting disadvantaged and migrant women will be necessary to reduce inequity. Currently, qualitative research among women from low socio-economic status, is conducted to explore barriers to screening.
Post-menopausal women do not seem to be aware of their risk of cervical risk. After 55y coverage drops to 50%.
The relationship between disability status and screening is currently under investigation.
25% of women with screen-detected abnormalities do not receive adequate follow up. A fail safe system will be set up.
Since 2010, the Flemish government has offered free HPV vaccinations to all girls in the first year of secondary education. About 82% of girls aged 13 are being vaccinated. In 2022, cohorts of young vaccinated women will enter the target population for screenin
- Targetting never of rarely screened women remains a priority.
- Changes in screening strategy (screening test, screening interval) may be necessary once women who were offered HPV vaccination, will reach the age of 25y.