title: Cervical cancer screening in Greenland, 1997-2011: Screening coverage and trends in the incidence of high-grade cervical lesions.
abstract: OBJECTIVE
  In spite of the high incidence of cervical cancer in Greenland, no assessment has been made of the impact of organized cervical screening, introduced in 1998, in relation to occurrence of high-grade cervical lesions. The objectives of the present study were to estimate coverage of the screening program and to examine possible changes in cervical intraepithelial neoplasia (CIN3) incidence in Greenland during 1997-2011 according to calendar period and age.
  
  
  METHODS
  Using nationwide registries, we calculated age-standardized incidence rates for all women born and living in Greenland. To investigate whether possible variation in the incidence of CIN3 were related to differences in screening coverage, we further estimated relative risks of CIN3 within two years of screening among women who participated in the screening program using log-linear binomial regression.
  
  
  RESULTS
  Coverage of the screening program was low during 1997-2011 with the highest level of 54% observed in 2011. Peaks in CIN3 incidence of around 300 per 100,000 person-years were observed in 1999 and between 2009 and 2011, while the incidence was lower of approximately 100 per 100,000 person-years between 2000 and 2008. During 2009-2011, the highest incidence was found among women aged 25-34 years. Similar patterns of CIN3 risk according to calendar period and age groups were observed among screened women.
  
  
  CONCLUSIONS
  The great variations in CIN3 incidence and low screening coverage observed during 1997-2011 suggest that improvements in the Greenlandic screening program are warranted.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark. Electronic address: SIHO@ssi.dk.
authors.forename: Signe
authors.initials: S
authors.lastname: Holst
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Wohlfahrt
authors.affiliation: Unit of Virus, Lifestyle and Genes, The Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Kjær
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Kamper-Jørgensen
authors.affiliation: Department of Gynecology and Obstetrics, Queen Ingrid's Hospital, Nuuk, Greenland.
authors.forename: Peder
authors.initials: P
authors.lastname: Kern
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark.
authors.forename: Mikael
authors.initials: M
authors.lastname: Andersson
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D006116:Greenland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D060787:Neoplasm Grading; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
keywords: Cervix cancer; Cohort studies; Prevention; Registers; Screening