title: Impact of opportunistic testing in a systematic cervical cancer screening program: a nationwide registry study.
abstract: BACKGROUND
  Systematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer. However, even in systematic screening programs, many women are still tested opportunistically. This study aimed to determine the spread of opportunistic testing in a systematic cervical cancer screening program, the impact of opportunistic testing in terms of detecting cytological abnormalities and examine the associations between sociodemography and opportunistic testing.
  
  
  METHODS
  A nationwide registry study was undertaken including women aged 23-49 years (n = 807,624) with a cervical cytology between 2010 and 2013. The women were categorised into: 1) screening after invitation; 2) routine opportunistic testing, if they were either tested more than 9 months after the latest invitation or between 2.5 years and 3 years after the latest cervical cytology and 3) sporadic opportunistic testing, if they were tested less than 2.5 years after the latest cervical cytology. Cytological diagnoses of women in each of the categories were identified and prevalence proportion differences (PPD) and 95% confidence intervals (CIs) were used to explore group differences. Associations between sociodemography and undergoing opportunistic testing were established by multinomial logistic regression.
  
  
  RESULTS
  In total, 28.8% of the cervical cytologies were due to either routine (20.7%) or sporadic (8.1%) opportunistic testing. Among women undergoing routine opportunistic testing, a larger proportion had high-grade squamous intraepithelial abnormalities than invited women (PPD: 0.6%, 95 % CI: 0.03-1.17%). A similar proportion of cytological abnormalities among women undergoing sporadic opportunistic testing and invited women was found. In multivariate analyses, younger age, being single or a social welfare recipient and residence region (North Denmark) were especially associated with opportunistic testing (routine or sporadic).
  
  
  CONCLUSIONS
  One fourth of cervical cytologies in this study were collected opportunistically. Compared to invited women, women undergoing routine opportunistic testing were more likely to be diagnosed with abnormal cytologies. Hence, routine opportunistic testing might serve as an important supplement to the systematic screening program by covering non-participating women who may otherwise be tested with a delay or not tested at all. Among women tested more often than recommended (sporadic testing), no benefits in terms of detecting more cytological abnormalities were identified.
authors.affiliation: Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark. mettrani@rm.dk.
authors.forename: Mette
authors.initials: M
authors.lastname: Tranberg
authors.affiliation: Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark. mebla@rm.dk.
authors.forename: Mette Bach
authors.initials: MB
authors.lastname: Larsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark. em@clin.au.dk.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Mikkelsen
authors.affiliation: Department of Pathology, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark. hans.svanholm@randers.rm.dk.
authors.forename: Hans
authors.initials: H
authors.lastname: Svanholm
authors.affiliation: Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark. berand@rm.dk.
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000367:Age Factors; D003718:Denmark; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012042:Registries; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D014626:Vaginal Smears