Exploring the trend of increased cervical intraepithelial neoplasia detection rates in the Netherlands. (September 2015)

• Record Type: Journal Article
• Authors: Rozemeijer, Kirsten; van Kemenade, Folkert J; Penning, Corine; Matthijsse, Suzette M; Naber, Steffie K; van Rosmalen, Joost; van Ballegooijen, Marjolein; de Kok, Inge MCM
• Is Part Of: Journal of medical screening. Volume 22:Number 3(2015)
• Page Start: 144
• Page End: 150
• Publication Date: 2015-09
• Subjects: cervical cancer -- screening -- trend -- cervical intraepithelial neoplasia; Medical screening -- Periodicals; 362.177
• DOI: 10.1177/0969141315580836
• Languages: English
• ISSNs: 0969-1413

Abstract

Objective: Over the last decade, cervical intraepithelial neoplasia (CIN) detection has increased in the Netherlands. We investigated the underlying mechanism by quantifying the increase, and analyzing patterns of CIN and cervical cancer detection over time. Methods: We observed annual CIN and cervical cancer detection rates (DRs) per 10, 000 primary smears within the Dutch screening programme for 2000–2011. Joinpoint analyses were performed to determine changes in time trends, logistic regression analyses to assess the relative risk of calendar time on histological outcomes, adjusted for demographic factors and type of primary cytology test used. Results: Trends of increased detection occurred for all CIN grades (ie. DRs increased from 17.8 to 36.1, from 21.0 to 35.5, and from 43.4 to 64.6 for CIN I, II, and III from 2003 to 2009). After adjusting for demographic factors, DRs were still 2.11 (95% confidence interval (CI): 1.95, 2.29), 1.79 (95% CI: 1.66, 1.92) and 1.59 (95% CI: 1.50, 1.67) times larger in 2009. When also adjusting for the type of cytology test, DRs were 1.90 (95% CI: 1.62, 2.22), 1.48 (95% CI: 1.22, 1.79) and 1.55 (95% CI: 1.39, 1.73) times larger. No trends in cervical cancer DRs were found. Conclusions: The implementation of liquid-based cytology contributed to the CIN increase. If some of these extra detected CIN are regressive this leads to overdiagnosis. Other factors, such as an increased cervical cancer risk, and implementation of imaging-assisted reading, could also have contributed.