title: Effects of streamlining cervical cancer screening the Dutch way: consequences of changes in the Dutch KOPAC-based follow-up protocol and consensus-based limitation of equivocal cytology.
abstract: OBJECTIVE
  To analyze the impact of the 1995 revision of the Dutch cervical screening program guidelines (e.g., the introduction of more stringent criteria for cytologic diagnosis of atypical squamous cells of undetermined significance [ASCUS]) on the negative side effects of screening in Region West.
  
  
  METHODS
  The data for this study were retrieved as two complementary datasets, both of which contained data on the invited screenees, including their cytology and histology follow-up. One dataset additionally included data on other smears. For invited screenees, we analyzed changes in cytoscores and histoscores between 1994, the last year before new screening guidelines were implemented, and 2003, the latest year for which follow-up to screening abnormalities was available in the retrieved data. Additionally, we analyzed changes in the total number of primary and repeat smears made.
  
  
  RESULTS
  Between 1994 and 2003, the cytoscore for ASCUS decreased from 19.4% to 1.3% of screenee smears. The total number of smears taken decreased by 30%. The cervical intraepithelial neoplasia 3+ histoscore remained the same (OR = 0.97, p = 0.91).
  
  
  CONCLUSIONS
  The reduction of equivocal ASCUS diagnoses resulted in a decrease of costly repeat smears, without measurably decreasing the effectiveness of the screening program.
authors.affiliation: Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Briët
authors.forename: Thomas H D
authors.initials: TH
authors.lastname: Berger
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Mathilde E
authors.initials: ME
authors.lastname: Boon
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D002985:Clinical Protocols; D003245:Consensus Statements as Topic; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology / Q000592:standards; D006801:Humans; D008403:Mass Screening; D009426:Netherlands; D010338:Pathology, Clinical / Q000592:standards; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000592:standards*