Screening history in women with cervical cancer in a Danish population-based screening program

Objective.The aim of this study was to explore the screening histories of all cervical cancers in a Danish screening population. The intention was to decide suboptimal sides of the screening program and to evaluate the significance of routine screening in the development of cervical cancer.Methods.The study describes the results of a quality control audit, performed on all new cervical cancer cases diagnosed in the years 2008–2009 at two major Danish screening-centers. All relevant cytological and histological cervical samples were reviewed.Results.202.534 cytological samples were evaluated in the study period, while 112 women were diagnosed with cervical cancer. The histological diagnoses comprised: 62 (55.4%) squamous cell carcinomas, 20 (17.9%) microinvasive squamous cell carcinomas, 25 (22.3%) adenocarcinomas and 5 cancers of different histology. The mean age of study subjects was 46.6 years. 51 (45.5%) women had deficient screening histories, while 45 (40.2%) women had followed the screening recommendations and had normal cervical samples in review. 11 (9.8%) women were diagnosed with false negative cytology, 2 women had false negative histological tests, while pathological review was not feasible for 3 subjects.Conclusions.More than 45% of the cervical cancer cases in our study were due to deficient cervical screening, stressing the importance of increasing the screening-uptake and coverage. 40% interval cancers emphasize the relevance of further cervical testing of women with relevant symptoms, despite of prior normal cervical samples. Finally, 9.8% false negative cytological samples are consistent with previous reports, but still a part of the screening program that should be improved.

Research Highlights
► 45.5% of cervical cancers are diagnosed in women with deficient screening-history.
► 40.2% of cervical cancers are diagnosed in women with regular screening-history.
► Audit of a cervical screening-program revealed 9.8% false negative cytological samples.