Barken, Sidsel S4; Lynge, Elsebeth5; Andersen, Erik S.3; Rebolj, Matejka5
1 Center of Epidemiology and Screening, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 unknown4 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet5 Center of Epidemiology and Screening, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
nationwide population-based study
OBJECTIVE: To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia. DESIGN: Prospective, population-based, register study. SETTING: Denmark, 1996-2007. POPULATION: All women treated for cervical intraepithelial neoplasia with conization. METHODS: Treated women were routinely recommended to have follow-up with annual smears for at least 5 years. MAIN OUTCOME MEASURES: Using individually linked nationwide register data on conizations and follow-up tests (smears and biopsies), we calculated the cumulative proportion of treated women undergoing the recommended follow-up. We measured this cumulative proportion conservatively in 15-month intervals for 5 years. RESULTS: Adherence to annual follow-up among 45 984 treated women decreased gradually. In total, 90% of these women obtained at least one smear in the first post-treatment year, but only 40% obtained the recommended tests for 5 years. Five-year adherence was substantially better outside the capital area, for example, the odds ratio for women from Jutland compared with women from the capital area was 1.70 (95% confidence interval 1.60-1.82). CONCLUSIONS: Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.
Acta Obstetricia Et Gynecologica Scandinavica, 2013, Vol 92, Issue 7, p. 852-857