Organised vs. spontaneous pap-smear screening for cervical cancer: A case-control study

Abstract

To compare the effect of organised pap‐smear screening for cervical cancer with that of the spontaneous one on the incidence of invasive cervical cancer, we performed a case‐control study within the catchment area of the Helsinki University Hospital (Helsinki, Finland). The study material consisted of 179 incident cases of invasive cervical cancer and 1,507 population controls. Data on lifetime pap smears before the year of the cancer diagnosis were collected using a self‐administered questionnaire. The questionnaire information was obtained for 82% of the cases and 73% of the controls. The main outcome measure was relative risk of invasive cervical cancer among those with history of organised or spontaneous screening compared with risk among those with no history of screening for cervical cancer, measured as odds ratios (OR) with 95% confidence intervals (CI) and computed with logistic regression. Odds ratio of invasive cervical cancer among those who participated in the organised screening programme was 0.38 (CI 0.26–0.56) whereas any lifetime spontaneous pap smear had an OR value of 0.82 (CI 0.53–1.26), in terms of unit risk for those not subjected to any screening and adjusted for age and the other type of the screening activity. Our results indicate that the substantial decrease in the incidence of and mortality due to cervical cancer in Finland is mainly due to the organised mass‐screening. Int. J. Cancer 83:55–58,1999. © 1999 Wiley‐Liss, Inc.

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

“…The opportunistic testing was shown to be of low effectiveness and most of the diagnoses in test positives but episode negatives were likely due to monitoring in the programme. 30 Our results apply to high resource countries with a high standard of health services. However, the magnitude of the cervical cancer problem is large in low and medium resource countries.…”

Impact of the introduction of organised screening for cervical cancer in Turin, Italy: cancer incidence by screening history 1992–98

“…The alternative hypothesis is that screening in the organised programme was more protective than opportunistic activity. A greater effectiveness of organised than spontaneous activity was observed in Finland (Nieminen et al, 1999).…”

Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland

“…33 The authors suggested that a reason for this might be selection of women with a lower risk to opportunistic screening. Our study supports this explanation as more than half (60%) of women attending opportunistic screening also participate organised screening (Fig.…”