title: Attendance at cervical cancer screening and use of diagnostic and therapeutic procedures on the uterine cervix assessed from individual health insurance data (Belgium, 2002-2006).
abstract: OBJECTIVE
  To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.
  
  
  METHODS
  The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25-64 that had a Pap smear within the last 3 years.
  
  
  RESULTS
  Cervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004-2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25-34 year old women, 67% for those aged 35-39 years, and decreased to 44% in the age group of 60-64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004-2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively.
  
  
  CONCLUSIONS
  The screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.
authors.affiliation: Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
authors.affiliation: Intermutualistic Agency (IMA/AIM), Brussels, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Fabri
authors.affiliation: Department of Gynaecology and Obstetrics, Ghent University, Ghent, Belgium; Director, Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium.
authors.forename: Cindy
authors.initials: C
authors.lastname: Simoens
mesh_terms: D000328:Adult; D000367:Age Factors; D001530:Belgium / Q000453:epidemiology; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003127:Colposcopy; D019092:Conization; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D007348:Insurance, Health; D008875:Middle Aged; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*