Effects of Streamlining Cervical Cancer Screening the Dutch Way Consequences of Changes in the Dutch KOPAC-Based Follow-up Protocol and Consensus-Based Limitation of Equivocal Cytology

Objective To analyze the impact of the 1995 revision of the Dutch cervical screening program guidelines (e g, the introduction of more stringent criteria for cytologic diagnosis of atypical squamous cells of undetermined significance [ASCUS]) on the negative side effects of screening in Region West Study Design The data for this study were retrieved as two complementary datasets, both of which contained data on the invited screenees, including their cytology and histology follow-up One dataset additionally included data on other smears For invited screenees, we analyzed changes in cytoscores and histoscores between 1994, the last year before new screening guidelines were implemented, and 2003, the latest year for which follow-up to screening abnormalities was available in the retrieved data Additionally, we analyzed changes in the total number of primary and repeat smears made Results Between 1994 and 2003, the cytoscore for ASCUS decreased from 19 4% to 1 3% of screenee smears The total number of smears taken decreased by 30% The cervical intraepithelial neoplasia 3+ histoscore remained the same (OR = 0 97, p = 0 91) Conclusion The reduction of equivocal ASCUS diagnoses resulted in a decrease of costly repeat smears, without measurably decreasing the effectiveness of the screening program (Acta Cytol 2010,54 1095-1100)