[Less pap-2 results ('minor abnormalities') in the population screening for cervical cancer since the introduction of new guidelines in 1996].
OBJECTIVE
To determine whether the 1996 implementation of new guidelines for the classification and management of cervical smears in the Dutch population screening programme for cervical cancer (i.e. inflammatory symptoms are no longer classified as moderate dysplasia and women with two smears with moderate dysplasia are referred directly to the gynaecologist) was followed by a reduction in both the number of women with repeat smears and the length of follow-up.


METHODS
The results of all smears of women aged 35-54 years from 1990 onwards, were retrieved from the Dutch Network and National Database for Pathology (PALGA). The percentage of smears with moderate dysplasia was analysed with respect to time. The percentage of women with a histological examination during the follow-up phase of the population screening programme (1990 and 1991) was compared with that for the new screening programme (1996).


RESULTS
Following the implementation of the new guidelines, the percentage of smears with moderate dysplasia was reduced from 10% to 2%. The percentage of women with a histological examination during the follow up of two smears with moderate dysplasia remained the same. The new recommendations for additional smears were not followed: for 28% no repeat smear was available after 2.25 years versus 10% in 1992. There were indications that the referral of women with two cases of moderate dysplasia to a gynaecologist was not strictly adhered to either. Since the introduction of the new guidelines, the estimated percentage of women that should be referred to the gynaecologist following smears with moderate dysplasia has not changed.


CONCLUSIONS
The new recommendations have lead to fewer smears being classified as moderate dysplasia. The long-term effects, such as a reduction in the length of the follow-up period, can only be analysed in a few years time.
Bos
A B
AB
Instituut Maatschappelijke Gezondheidszorg, Postbus 1738, 3000 DR Rotterdam. abos@mgz.fgg.eur.nl
van Ballegooijen
M
M
van den Akker-van Marle
M E
ME
Habbema
J D F
JD
D000328:Adult; D002584:Cervix Uteri / Q000166:cytology* / Q000473:pathology; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000175:diagnosis; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000379:methods*