Screening for cervical carcinoma

Abstract

Background: Differences exist between defined groups of women in their attendance to screening programs for cervical carcinoma. Data from the screening organization in the southwest Netherlands were used to evaluate differences between subpopulations to get information to improve the screening procedure.

Methods: Between 1998 and 2001, a total of 251,446 women had been invited to participate in the screening program. The ethnic background of all invited women was documented. Both the results of Papanicolaou tests and the reason women did not participate were stored in a data base that was matched with the invitation data base. The resulting data set was analyzed with regard to participation rates and results of screening in relation to age, ethnic background, and socioeconomic status.

Results: Overall participation was 55.7%. Women who were born in The Netherlands participated at a rate of 56.8%, whereas women who were born in other Western countries participated at a rate of 45.3%. The participation rate for women who had a Moroccan background was as low as 35.9%. The prevalence of high-grade squamous intraepithelial lesion was 6.2 times higher among women in the younger age groups compared with women in the oldest age group. Women with low socioeconomic status were 1.5 times more likely to have high-grade squamous intraepithelial lesions. Women from The Netherlands Antilles had greater percentages of both low-grade and high-grade squamous intraepithelial lesions (1.6 and 3.0 times more frequent, respectively) compared with women who were born in The Netherlands.

Conclusions: Although cervical screening is free of charge in The Netherlands, participation rates differed greatly between ethnic groups and between women from different socioeconomic strata. Abnormalities were found more often in women who were not born in The Netherlands and in women with lower socioeconomic status. In these groups, attendance at the screening program was lower compared with the attendance of women who were born in The Netherlands.