Cytology history preceding cervical cancer diagnosis: a regional analysis of 286 cases.

Cervical cancer is preceded by well-defined premalignant lesions, which can be identified by detecting abnormal cells in Papanicolaou smear. Cervical screening by cytology with adequate treatment have resulted in a decrease in incidence and mortality of cervical carcinoma (Gustafsson et al, 1997; Vizcaino et al, 2000). In the Dutch screening programme, women aged 30–60 years are invited every 5 years for seven times in a lifetime. Modelling, before the introduction of the Dutch cervical screening programme, predicted a decrease in cervical carcinoma by approximately 75%, assuming full coverage (van Ballegooijen, 1998) within the range mentioned in other studies (Sasieni and Adams, 1999; IARC, 2005). Coverage of the screening programme is currently 77% (Rebolj et al, 2007). Approximately 65% of women attend the screening programme after an invitation, referred to as smears made inside the screening programme and 12% reflects smears made outside the screening programme (opportunistic smears). Approximately 23% of the invited women will not be screened at all (Bais et al, 2007). Collectively, the effect on carcinoma incidence through these two modes of screening will be lower than modelled for the programme, as full coverage is not attained. Moreover, the non-participating fraction of women (referred to as non-attendees) has a higher risk for cervical carcinoma than average, thus further decreasing the effectiveness of a programme in reducing carcinoma incidence (van Oortmarssen and Habbema, 1991). Earlier studies have shown that 40–50% of the women diagnosed with cervical cancer are in the non-compliance group (van der Graaf et al, 1986; Bos et al, 2006). Here we analysed 286 women, with cervical carcinoma from the region Noord-Holland/Flevoland in the Netherlands, diagnosed between 2005 and 2007. We analysed the relationship between the FIGO (International Federation of Gynaecology and Obstetrics) stage of the detected carcinoma and the associated screen status. In addition, we analysed whether the smear was made within or outside the screening programme, and the compliance for referral to the gynaecologist in case of an abnormal smear.