The effect of extended participation windows on attendance at cervical cancer screening

Kelly M Castañeda; Grigory A Sidorenkov; Jolien de Waard; Marcel J W Greuter; Bert van der Vegt; Inge M C M de Kok; Albert G Siebers; Karin M Vermeulen; G Bea A Wisman; Ed Schuuring; Geertruida H de Bock

doi:10.1016/j.pmedr.2023.102166

The effect of extended participation windows on attendance at cervical cancer screening

Prev Med Rep. 2023 Feb 27:32:102166. doi: 10.1016/j.pmedr.2023.102166. eCollection 2023 Apr.

Affiliations

¹ Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, the Netherlands.
² Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, the Netherlands.
³ Department of Radiology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, the Netherlands.
⁴ Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, the Netherlands.
⁵ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands.
⁶ PALGA, the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands, 3991 SZ Houten, the Netherlands.

Abstract

Research has long since confirmed the benefits of regular cervical cancer screening (CCS) worldwide. However, some developed countries have low participation rates despite well-organized screening programs. Given that studies in Europe typically define participation in 12-month windows from an invitation, we evaluated both whether extending this defined time window could reveal the true participation rate and how sociodemographic determinants affect participation delays. This involved linking data from the Lifelines population-based cohort with CCS-related data from the Dutch Nationwide Pathology Databank and including data for 69 185 women eligible for screening in the Dutch CCS program between 2014 and 2018. We then estimated and compared the participation rates for 15- and 36-month time windows and categorized women by the primary screening window into timely participation (within 15 months) and delayed participation (within 15-36 months) groups, before performing multivariable logistic regression to evaluate the association between delayed participation and the sociodemographic determinants. Participation rates for the 15- and 36-month windows were 71.1% and 77.0%, respectively, with participation considered timely in 49 224 cases and delayed in 4047 cases. Delayed participation was associated with age 30-35 years (odds ratio [OR]: 2.88, 95 %CI: 2.67-3.11), higher education (OR: 1.50, 95 %CI: 1.35-1.67), the high-risk human papillomavirus test-based program (OR: 1.67, 95 %CI: 1.56-1.79), and pregnancy (OR: 4.61, 95 %CI: 3.88-5.48). These findings show that a 36-month window for monitoring attendance at CCS better reflects the actual participation rate by accommodating possible delayed uptake among younger, pregnant, and highly educated women.

Keywords: CCS, cervical cancer screening; Early detection of cancer; PALGA, Dutch Nationwide Pathology Databank; Patient compliance; Uterine cervical neoplasms; hrHPV, high-risk human papillomavirus.