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M van Ballegooijen

Publications and source records attributed to M van Ballegooijen.

33 records · Page 2Linked to original sources
PubMed1998

Organised cervical cancer screening still leads to higher coverage than spontaneous screening in The Netherlands.

In The Netherlands, early detection of cervical cancer by programme and spontaneous screening has been common practice for more than two decades. Both types of screening are mainly performed by general practitioners. Therefore, the question is raised of whether programme screening still enhances screening uptake. To answer this question, we analysed the national health interview survey in the years 1992-1996. The coverage rate, defined as the percentage of women with at least one smear taken in the previous 5 years, was 91% for women invited for programme screening compared with 68% for women not invited. The performance of the organised programme in reducing excessive screening, i.e. smears taken in excess of the recommended age and interval range, was not clear and the effect seemed small. Furthermore, we found that half the non-attenders were 'protected' by a recent smear or a hysterectomy, and of the unprotected women, 72% showed a positive attitude towards the programme. We conclude that even after a long history of cervical cancer screening, an organised programme is still required to ensure a high coverage.

Adult↗
PubMed1998

Positive diagnostic values and histological detection ratios from the Rotterdam cervical cancer screening programme.

BACKGROUND: In organized screening programmes for cervical cancer, pre-cancerous lesions are detected by cervical smears. However, during follow-up after a positive smear these pre-cancerous lesions are not always found. The purpose of the study is to analyse positive diagnostic values of smears of at least mild dysplasia, made under the organized screening programmes in the Rotterdam area (1979-1991), and detection ratios of histologically confirmed CIN > or =3, among women participating in these screening programmes. METHODS: Positive diagnostic values and histological detection ratios, by age and history of previous smears, recorded during the national screening programme (1989-1991), were compared with those of the experimental cervical cancer screening project (1976-1984). RESULTS: The positive diagnostic value of a smear with at least severe dysplasia (histologically confirmed CIN > or =3) remains approximately 78%. For smears with mild and moderate dysplasia only lower limits of the diagnostic value could be determined. This was 9% for a smear with mild dysplasia obtained during the national screening programme and 25% and 35% for smears with moderate dysplasia taken during the experimental and national screening programmes respectively. Histological detection ratios for CIN > or =3 in the three rounds of the experimental screening project were 4.7, 2.9 and 1.9. In the first round of the national screening programme the ratio was 4.7, and about three times higher in younger compared to older women. CONCLUSION: Immediate referral for colposcopy after a smear showing moderate dysplasia seems questionable. Whether the increased detection ratio among young women indicates a rise in the risk of cervical cancer is unclear.

Adult↗
PubMed1997

Non-progression of cervical intraepithelial neoplasia estimated from population-screening data.

Non-progression and duration of preclinical neoplastic lesions of the cervix uteri were studied using screening data from a previously unscreened population, Maribo County, Denmark (1966-82). To estimate regression rates, the incidence of clinical cancer before the screening programme was related to the prevalence and incidence of preclinical lesions estimated from the detection rates of first smear and third and subsequent smears respectively. Duration was estimated from the time lag between the cumulative incidence of preclinical lesions and the combined cumulative incidence of clinical cancer and the estimated 'incidence of regression'. Of all preclinical lesions in women aged 25-50, 24% progressed, 39% regressed and 38% remained. Even if we assume no onset of preclinical lesions above age 50, we estimated that 48% of the preclinical lesions would not progress to clinical cancer in the women's lifetime. The estimated mean duration of preclinical lesions was 16 years. In Maribo County during the 1970s, the positive rate (1.6%) was low compared with current rates in several countries. We conclude that the detection of non-progressive lesions was outweighed by the prevention of clinical cancer.

Adult↗
PubMed1997

Present evidence on the value of HPV testing for cervical cancer screening: a model-based exploration of the (cost-)effectiveness.

Human papillomavirus (HPV) is the main risk factor for invasive cervical cancer. High risk ratios are found in cross-sectional data on HPV prevalence. The question raised is whether this present evidence is sufficient for making firm recommendations on HPV screening. A validated cervical cancer screening model was extended by adding HPV infection as a possible precursor of cervical intraepithelial neoplasia (CIN). Two widely different model quantifications were constructed so that both were compatible with the observed HPV risk ratios. One model assumed a much longer duration of HPV infection before progressing to CIN and a higher sensitivity of the HPV test than the other. In one version of the model, the calculated mortality reduction from HPV screening was higher and the (cost-)effectiveness was much better than for Pap smear screening. In the other version, outcomes were the opposite, although the cost-effectiveness of the combined HPV + cytology test was close to that of Pap smear screening. Although small follow-up studies and studies with limited strength of design suggest that HPV testing may well improve cervical cancer screening, only large longitudinal screening studies on the association between HPV infection and the development of neoplasias can give outcomes that would enable a firm conclusion to be made on the (cost-)effectiveness of HPV screening. Prospective studies should address women aged 30-60 years.

Adult↗
PubMed1996

PCR-based high-risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears.

Cervical-cancer screening programmes using cytomorphological criteria could be more efficient if the screening included objective individual risk factors for women with normal cytology, such as a test for high-risk human papillomavirus (HPV). The value of a PCR-based test for high-risk HPV types was studied in a cohort of 1622 women presenting in a routine triannual population-based screening programme. Women were included in the study when they had no previous history of cervical dysplasia; and their initial Pap smear was read as normal (Pap 1 or 2). The mean age of the women was 42 years (range 34-54 years) and mean follow-up time was 40 months (range 5-73 months). Women were referred for colposcopically directed biopsies if they had had 2 successive cervical smears read as Pap 3a (mild to moderate dyskaryosis) or one read as > or = Pap 3b (severe dyskaryosis). Women with histologically confirmed cervical intraepithelial neoplasia grade III (CIN III) were considered positive cases. All women were tested for 14 high-risk HPV genotypes. Of the 86 high-risk HPV-positive women, 6 developed CIN III, whereas only 1 of the 1536 HPV-negative women did. The women with normal Pap smears containing high-risk HPV genotypes were 116 times (95% CI, 13-990) more at risk of developing CIN III, in contrast to women without high-risk HPV. These results support the view that the interval between successive smears in cervical-cancer screening can be increased considerably for women with cytomorphologically normal and high-risk HPV-negative cervical smears as determined by PCR.

Adult↗
PubMed1995

The management of cervical intra-epithelial neoplasia (CIN): extensiveness and costs in The Netherlands.

In order to provide greater insight into both the extensiveness and the medical costs of the diagnosis and treatment of screen-detected cervical intra-epithelial neoplasia (CIN) in general medical practice in The Netherlands, data from national registries and gynaecology departments were retrieved, and experts were interviewed. Of the 5060 women diagnosed with CIN in 1988, more than 50% were treated in hospital with conisation or hysterectomy, which on average took 5.5 days stay per admission. The assessed average duration of the total pre- and post-treatment period is 4.6 years. The average total medical costs in women with detected CIN III are Dfl 3700 per woman. The diagnosis of CIN I and II involves more medical procedures and time than CIN III, but fewer women have conisation or hysterectomy, resulting in lower total medical costs (Dfl 2572). The overall extent and costs of the management of CIN should be accounted for when balancing the benefits, unfavourable effects and costs of cervical cancer screening.

Female↗
PubMed1992

Predicting mortality from cervical cancer after negative smear test results.

OBJECTIVE: To assess the relative protection against death from cervical cancer after two or more negative smear test results and compare it with the protection against invasive cancer estimated by an International Agency for Research on Cancer (IARC) working group in an analysis of data from 10 large screening programmes. DESIGN: Comparison of risk of death from cervical cancer after two or more negative smear results with the risk in unscreened women by using a model constructed with data from the British Columbia screening programme. MAIN OUTCOME MEASURES: Mortality from and incidence of invasive cancer. RESULTS: In women with two negative smear results estimates of protection against cervical cancer were about 50% higher when lethal invasive cancer was used as the criterion rather than all invasive cancer. This difference was due to these women being more likely to attend for further tests at which invasive cancer could be detected: screen detected cancer has a better prognosis than clinically diagnosed cancer. Screening intervals could be longer than three years: screening women aged 35-64 every five years was predicted to result in a 90% reduction in mortality from cervical cancer. CONCLUSION: Because protection from mortality is higher than protection from disease and because of the high costs and negative side effects of frequent screening, screening intervals should be longer than three years.

Adult↗
PubMed1992

Care and costs for advanced cervical cancer.

The types, amounts and costs of hospital and home care in patients who died from cervical cancer are investigated, using both national data sources and hospital files. Our goal has been assessment of the savings on treatment and care of advanced cervical cancer resulting from cervical cancer screening. Hospital costs account for 70% of the total cost per patient of Dfl 29,200. The amount of hospital care decreases significantly with increasing age. The average number of days of hospitalisation per patient with advanced disease decreases from 62 days below age 50 to less than 10 days at age 70 and older. In-hospital medical procedures, home care and nursing home care account for 24, 22 and 8% of the costs, respectively. Mass screening programmes for cervical cancer will result in a reduction in both advanced disease and mortality. The potential savings compensate approximately 10% of the costs of screening.

Adult↗
PubMed1992

Preventive Pap-smears: balancing costs, risks and benefits.

The pattern of spontaneous screening for cervical cancer by general practitioners and gynaecologists in The Netherlands is compared with an efficient screening policy resulting from a cost-effective study. Spontaneous screening tends to start and stop too early in a woman's life, and leaves too many women overscreened or unprotected. The combination in young age of a low incidence of invasive cancer and a high incidence of regressive lesions explains relative ineffectiveness and harmfulness of present screening practice. When screening would take place between ages 30 and at least 60, with intervals of about 5 years, as many lives could be saved for half the costs and with only 60% of the unnecessary referrals and treatments. Much attention should be paid to the coverage of the target population. Therapeutic follow-up policies for dysplastic lesions should be restrained.

Age Factors↗
PubMed1990

Cervical-cancer screening: attendance and cost-effectiveness.

The influence of attendance on the health effects and cost-effectiveness of cervical-cancer screening was studied, both for organized screening programmes and for spontaneous screening. The asymmetric distribution of smears among the female population and the higher risk incurred by women who never or only occasionally attend screening appear crucial in determining the health effects of screening. An increase in attendance rate induces a substantial rise in health effects and a less than proportionate rise in costs, thus improving cost-effectiveness. Wider screening coverage, in order to increase the number of life-years saved, is achieved more efficiently by encouraging a greater number of women to attend than by inviting the same number of women to attend more often, i.e., with a shorter interval between successive screens. Spontaneous screening is characterized by high coverage for younger women and low coverage for middle-aged and older women. This leads to a small amount of health effects and poor cost-effectiveness as compared with organized screening.

Adult↗
PubMed1990

Diagnostic and treatment procedures induced by cervical cancer screening.

The amount of diagnostic and treatment procedures induced by cervical cancer screening has been assessed prospectively and related to mortality reduction. Assumptions are based on data from Dutch screening programmes and on a scenario for future developments. With 5 invitations for screening, between ages 37-70 every eight years, 13 deaths are avoided per million women per screening year. Each death avoided is balanced by 2800 preventive smears, 9 women referred to a gynaecology department and 4 minor treatment procedures (conserving treatment or exconisation). 25 invitations in a life-time avoids 27 deaths per million women per screening year but with 7300 preventive smears, 22 referrals and 8 small treatment procedures. Thus intensifying screening will not only result in diminishing returns of extra screening efforts, but also in increasing risk for women to undergo unnecessary (no invasive disease or death avoided) diagnostic and treatment procedures. The balance between beneficial and adverse effects deteriorates strongly when hysterectomies play an important part in the management of cervical intraepithelial neoplasia.

Adult↗
PubMed1990

Economic aspects of cervical cancer screening.

The results of a cost-effectiveness analysis of cervical cancer screening in The Netherlands are reported, emphasizing the analysis of the costs of screening and consequent diagnosis and treatment. Many organized screening policies are evaluated, differing in age-range and interval between screens. The cost estimates are based on organization charts, file studies and tariffs. The costs of screening itself are by far the most important cost component. Screening increases the costs of diagnosis. Costs for primary treatment only rise for large screening policies. Screening causes savings in costs of terminal treatment, but these are small compared with the costs of screening. The costs per life-year gained for the most efficient policies amount to DFL 24,000 for the policy with 7 invitations per woman in a lifetime and rise considerably in case of more than 10 invitations. Cervical cancer screening appears to be less cost-effective than breast cancer screening, but compared with other services the results are comparatively good. Implementing one of the efficient organized screening policies and discouraging spontaneous screening beyond that schedule leads to considerable savings. Moreover, many organized policies which are not efficient are still superior to spontaneous screening.

Adult↗
PubMedDate not supplied

Cost analysis of PAPNET-assisted vs. conventional Pap smear evaluation in primary screening of cervical smears.

OBJECTIVE: To assess the difference in costs between PAPNET-assisted and conventional microscopy of cervical smears when used as a primary screening tool. STUDY DESIGN: We performed time measurements of the initial screening of smears by four cytotechnologists in one laboratory. Time was measured in 816 conventionally screened smears and in 614 smears with PAPNET-assisted screening. Data were collected on the components of initial screening, clerical activities and other activities in the total work time of cytotechnologists in the routine situation and on resource requirements for both techniques. RESULTS: PAPNET saved an average of 22% on initial screening time per smear. Due to costs of processing and additional equipment, the costs of PAPNET-assisted screening were estimated to be $2.85 (and at least $1.79) higher per smear than conventional microscopy. The difference in costs is sensitive to the rate of time saving, the possibility of saving on quality control procedures and the component of the initial screening time in the total work time of cytotechnologists. CONCLUSION: Although PAPNET is time saving as compared with conventional microscopy, the associated reduction in personnel costs is outweighed by the costs of scanning the slides and additional equipment. This conclusion holds under a variety of assumptions. Using PAPNET instead of conventional microscopy as a primary screening tool will make cervical cancer screening less cost-effective unless the costs of PAPNET are considerably reduced and its sensitivity and/or specificity are considerably improved.

Cost-Benefit Analysis↗
PubMedDate not supplied

Rescreen effect in conventional and PAPNET screening: observed in a study using material enriched with positive smears.

OBJECTIVE: To study the rescreen and PAPNET effects on enriched material derived from smears screened routinely using PAPNET and conventional microscopy. STUDY DESIGN: A series of 432 smears (containing 122 atypical squamous cells of undetermined significance [ASCUS] plus 44 at least dysplastic squamous intraepithelial lesion-positive [SIL+] ones), screened routinely with the conventional method, were rescreened using the PAPNET system. Another series of 461 smears (containing 140 ASCUS + 52 SIL+ ones) screened routinely with PAPNET were rescreened conventionally. The rescreen effect, defined as the effect of differences between the rescreen and routine screening situation, was investigated by comparing the rescreen results in both series of smears with the routine results in both series. The effect of using either method of screening was studied by comparing the PAPNET results in both series with the results of conventional screening in both series. RESULTS: The rescreen effect was statistically significant both for a higher number of smears classified as negative (less than ASCUS) and a higher number of smears classified as high grade SIL or more. PAPNET-assisted screening resulted in a significantly higher number of smears classified as high grade SIL+, although for this latter finding there is an unexplained significant difference between conventional and PAPNET-screened cases in the changes made by the cytopathologist in the cytotechnologists' diagnoses. CONCLUSION: The rescreen effect should not be ignored when enriched material is used.

Carcinoma, Squamous Cell↗