The Danish Quality Database for Cervical Cancer Screening

Abstract

Aim of database: To monitor and improve the quality of the Danish national cervical cancer screening program, an annual report is published, including nine quality indicators.

Study population: The screening target group consisted of 1.5 million Danish women aged 23-64 years, but in the calculation of quality indicators, the dataset varies according to indicators being Danish women, cervical cancer cases, or cytology samples.

Main variables: The variables include the number of cytology samples per pathology laboratory, participation rate, percentage of unsatisfactory samples, diagnostic sensitivity and specificity, percentage of samples answered within ≤10 days, percentage of atypical squamous cells of undetermined significance samples in women aged >30 years with human papillomavirus-triage, coverage, percentage of non-normal samples not followed up according to recommendations, number of incident cervical cancers, incidence of cervical cancer in the past 5 years, and upcoming percentage of incident cervical cancers undergoing audit.

Descriptive data: Annual reports have been published since 2009. Better fulfillment of quality standards has been seen for the size of pathology departments, percentage of unsatisfactory samples, percentage of atypical squamous cells of undetermined significance with human papillomavirus-triage, and a slight decrease in the percentage of non-normal samples not followed up within the recommended time intervals. Stable patterns have been observed for participation rate, coverage, and number of incident cervical cancer cases. With a coverage of 75%, and with presently 16% of non-normal samples not followed up in a timely manner, there is definitely a scope for improvement in the screening program.

Conclusion: The database has pinpointed the strengths and weaknesses of the national cervical cancer screening program. Measures to enhance participation rate/coverage and to improve follow-up of non-normal cytology samples are warranted.

Keywords: cervical cancer; cytology; screening.

Figure 1

Danish cervical cancer incidence (red curve) and mortality (green curve) 1943–2013 (0–85 years of age). Notes: Age-standardized rate per 100,000 (Nordic standard population). In 1967, start of first organized county-based screening program; 1986, first national guidelines issued; 2007, new national guidelines issued; and 2012, updated national guidelines issued. Reproduced from Engholm G, Ferlay J, Christensen N, et al. NORDCAN: Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries, Version 7.2 (16.12.2015). Association of the Nordic Cancer Registries. Danish Cancer Society. Available from http://www.ancr.nu. Accessed March 16, 1016.