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Cervical cancer screening in the United States and the Netherlands: a tale of two countries.

Abstract

CONTEXT
This article compares cervical cancer screening intensity and cervical cancer mortality trends in the United States and the Netherlands to illustrate the potential of cross-national comparative studies. We discuss the lessons that can be learned from the comparison as well as the challenges in each country to effective and efficient screening.
METHODS
We used nationally representative data sources in the United States and the Netherlands to estimate the number of Pap smears and the cervical cancer mortality rate since 1950. The following questions are addressed: How do differences in intensity of Pap smear use between the countries translate into differences in mortality trends? Can population coverage rates (the proportion of eligible women who had a Pap smear within a specified period) explain the mortality trends better than the total intensity of Pap smear use?
FINDINGS
Even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries' mortality trends were quite similar. The five-year coverage rates for women aged thirty to sixty-four were quite comparable at 80 to 90 percent. Because screening in the Netherlands was limited to ages thirty to sixty, screening rates for women under thirty and over sixty were much higher in the United States. These differences had consequences for age-specific mortality trends. The relatively good coverage rate in the Netherlands can be traced back to a nationwide invitation system based on municipal population registries. While both countries followed a "policy cycle" involving evidence review, surveillance of screening practices and outcomes, clinical guidelines, and reimbursement policies, the components of this cycle were more systematically linked and implemented nationwide in the Netherlands than in the United States. To a large extent, this was facilitated by a public health model of screening in the Netherlands, rather than a medical services model.
CONCLUSIONS
Cross-country studies like ours are natural experiments that can produce insights not easily obtained from other types of study. The cervical cancer screening system in the Netherlands seems to have been as effective as the U.S. system but used much less screening. Adequate coverage of the female population at risk seems to be of central importance.

Links

  • Publisher Full Text
  • Authors

    Habbema D, De Kok IM, Brown ML

    Institution

    Erasmus MC University Medical Center.

    Source

    The Milbank quarterly 90:1 2012 Mar pg 5-37

    MeSH

    Alphapapillomavirus
    Cross-Cultural Comparison
    Female
    Guidelines as Topic
    Health Policy
    Humans
    Incidence
    Mass Screening
    Netherlands
    Papillomavirus Infections
    Physician's Practice Patterns
    Population Surveillance
    Public Health
    United States
    Uterine Cervical Neoplasms
    Vaginal Smears

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    22428690