Prospective Evaluation of Cervical Cancer Screening in the Netherlands
The Mass screening program on cervical cancer in the Netherlands started in 1976. Decision making on prolongation or modification of the program will depend on a careful evaluation of the results.
Effects of mass screening cannot be measured in a direct way, and therefore use of simulation models has been advocated, in order to estimate effects of different screening policies. A computer simulation programme which calculates the effects of screening in a birth cohort of the population has been developed by Knox. We extended this program to obtain predictionsof the effects for the population as a whole, and applied it to the dutch screening circumstances. When the effects of Papsmears made outside screening programs by general practitioners and gynaecologists are taken into account, the long term effect of mass screening on cervical cancer mortality is estimated to be a 35% decrease at most. The reliability of the results of the simulation model will improve when more results from (Dutch) mass screening and (Dutch) cancer and cytology registries become available, and by carefully assessing the sensitivity of results to variation of the model assumptions.
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