Differences in screening history, tumour characteristics and survival between women with screen-detected versus not screen-detected cervical cancer in the east of The Netherlands, 1992-2001

Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):204-9. doi: 10.1016/j.ejogrb.2007.10.017. Epub 2008 Feb 21.


Objective: In The Netherlands, despite a national screening programme since 1996, invasive cervical cancers have been detected in screened and non-screened women. The aim of this study was to determine differences between Pap-smear history, tumour characteristics and survival of patients with a tumour detected by the screening programme (SP) or outside the screening programme (OSP) in the region of the Comprehensive Cancer Centre Stedendriehoek Twente in the period 1992-2001.

Study design: In this period, 263 cervical cancer cases in women aged 30-60 were selected from the regional cancer registry. Patient and tumour characteristics, treatment and follow-up data were extracted. Also, detection modality of the tumour and Pap score of the smear which led to the diagnosis ('diagnostic smear') and the 'previous smear' were registered.

Results: Thirty-five percent were SP tumours and 65% were OSP tumours. SP tumours had a lower stage (FIGO I) than OSP tumours: 84% versus 57%. The OSP group exhibited a twofold increase in risk of death (p<0.05) compared to the SP group. Subsequently 61 women (23%) and 46 (17%) women had an abnormal Pap smear (Pap II or higher) 5 and 3 years before the 'diagnostic smear', respectively. Furthermore, 37 women (14%) and 23 women (9%) had a normal smear 5 and 3 years before diagnosis, respectively.

Conclusion: SP tumours have a lower stage and a better prognosis, probably due to the fact that the screening programme detects the slow growing tumours which in general have a better prognosis. Furthermore, detection and treatment of patients with suspicious smears have been suboptimal and attention should therefore be paid to prompt follow-up of suspicious smears.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Adult
  • Age Factors
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Female
  • Humans
  • Mass Screening*
  • Middle Aged
  • Neoplasm Staging
  • Netherlands
  • Papanicolaou Test
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology
  • Vaginal Smears