title: Participation in cervical cancer screening by age and region--a cohort study with a 3 1/2 year follow-up on 2,223,135 women in Bavaria.
abstract: OBJECTIVE
  Cervical cancer rates are higher in Germany than in comparable European countries. While other European countries have implemented invitation programs, Germany relied on annual free access only. Are sufficient screening participation rates achieved?
  
  
  METHODS
  We analyzed data from 2,223,135 Bavarian women between 2002/3 and 2005/4 in a retrospective cohort, to evaluate screening participation, frequency, age dependencies and regional differences.
  
  
  RESULTS
  The highest screening participation was amongst women between 20 and 29 (54.6% had at least one visit after one year, 84% within three years) and decreased progressively with increasing age. Participation was lowest for women above 70 in rural areas (in some regions less than 20% had at least one screening within three years).
  
  
  CONCLUSIONS
  Poor participation rates in general are unlikely to account for the high cervical cancer rates in Germany. Low participation rates in elderly women, particularly those in rural regions might contribute to the well-known peak of cervical cancer in elderly women.
authors.affiliation: University of Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, München. simon.rueckinger@med.unimuenchen.de
authors.forename: S
authors.initials: S
authors.lastname: Rückinger
authors.forename: M
authors.initials: M
authors.lastname: Tauscher
authors.forename: R
authors.initials: R
authors.lastname: Redel
authors.forename: A
authors.initials: A
authors.lastname: Munte
authors.forename: M
authors.initials: M
authors.lastname: Walchner-Bonjean
authors.forename: J
authors.initials: J
authors.lastname: Hess
authors.forename: A
authors.initials: A
authors.lastname: Schneider
authors.forename: R
authors.initials: R
authors.lastname: von Kries
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D016387:Women's Health