The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study
Abstract Background High coverage of a screening program is essential to program success. Many European screening programs cover only 10–80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2371-4 |
| _version_ | 1818032618612981760 |
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| author | Mette Bach Larsen Ellen M. Mikkelsen Ulla Jeppesen Hans Svanholm Berit Andersen |
| author_facet | Mette Bach Larsen Ellen M. Mikkelsen Ulla Jeppesen Hans Svanholm Berit Andersen |
| author_sort | Mette Bach Larsen |
| collection | DOAJ |
| description | Abstract Background High coverage of a screening program is essential to program success. Many European screening programs cover only 10–80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population. Methods A population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986). The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy. Results The coverage among women aged 26–49 years and 55–64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26–49 years) and 79.4% (55–64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes. Conclusions Excluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women. |
| first_indexed | 2024-12-10T06:10:14Z |
| format | Article |
| id | doaj.art-aecfc8d659ba42d09c786675e8a25d81 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T06:10:14Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-aecfc8d659ba42d09c786675e8a25d812022-12-22T01:59:34ZengBMCBMC Health Services Research1472-69632017-06-011711710.1186/s12913-017-2371-4The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional studyMette Bach Larsen0Ellen M. Mikkelsen1Ulla Jeppesen2Hans Svanholm3Berit Andersen4Department of Public Health Programs, Randers Regional HospitalDepartment of Clinical Epidemiology, Aarhus University HospitalDepartment of Gynaecology and Obstetrics, Randers Regional HospitalDepartment of Public Health Programs, Randers Regional HospitalDepartment of Public Health Programs, Randers Regional HospitalAbstract Background High coverage of a screening program is essential to program success. Many European screening programs cover only 10–80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population. Methods A population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986). The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy. Results The coverage among women aged 26–49 years and 55–64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26–49 years) and 79.4% (55–64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes. Conclusions Excluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women.http://link.springer.com/article/10.1186/s12913-017-2371-4Mass screeningUterine cervical neoplasmHysterectomySocioeconomic factor |
| spellingShingle | Mette Bach Larsen Ellen M. Mikkelsen Ulla Jeppesen Hans Svanholm Berit Andersen The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study BMC Health Services Research Mass screening Uterine cervical neoplasm Hysterectomy Socioeconomic factor |
| title | The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study |
| title_full | The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study |
| title_fullStr | The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study |
| title_full_unstemmed | The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study |
| title_short | The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study |
| title_sort | influence of total hysterectomy in a cervical cancer screening population a register based cross sectional study |
| topic | Mass screening Uterine cervical neoplasm Hysterectomy Socioeconomic factor |
| url | http://link.springer.com/article/10.1186/s12913-017-2371-4 |
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