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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Impact of opportunistic testing in a systematic cervical cancer screening program: a nationwide registry study

BMC Public Health > Ausgabe 1/2015
Mette Tranberg, Mette Bach Larsen, Ellen M. Mikkelsen, Hans Svanholm, Berit Andersen
Wichtige Hinweise
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1186/​s12889-015-2158-7.
An erratum to this article is available at http://​dx.​doi.​org/​10.​1186/​s12889-015-2158-7.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

BA and MBL conceived the primary idea of this study. MT, MBL, EM, and BA participated in the final design of the study. MT was primarily responsible for all data and statistical analyses and for drafting the manuscript. HS contributed with important insight into SNOMED coding and pathological patterns. All authors contributed to interpretation of results, revising the manuscript critically for important intellectual content, and approving the final version to be published. All authors read and approved the final manuscript.



Systematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer. However, even in systematic screening programs, many women are still tested opportunistically. This study aimed to determine the spread of opportunistic testing in a systematic cervical cancer screening program, the impact of opportunistic testing in terms of detecting cytological abnormalities and examine the associations between sociodemography and opportunistic testing.


A nationwide registry study was undertaken including women aged 23–49 years (n = 807,624) with a cervical cytology between 2010 and 2013. The women were categorised into: 1) screening after invitation; 2) routine opportunistic testing, if they were either tested more than 9 months after the latest invitation or between 2.5 years and 3 years after the latest cervical cytology and 3) sporadic opportunistic testing, if they were tested less than 2.5 years after the latest cervical cytology. Cytological diagnoses of women in each of the categories were identified and prevalence proportion differences (PPD) and 95 % confidence intervals (CIs) were used to explore group differences. Associations between sociodemography and undergoing opportunistic testing were established by multinomial logistic regression.


In total, 28.8 % of the cervical cytologies were due to either routine (20.7 %) or sporadic (8.1 %) opportunistic testing. Among women undergoing routine opportunistic testing, a larger proportion had high-grade squamous intraepithelial abnormalities than invited women (PPD: 0.6 %, 95 % CI: 0.03–1.17 %). A similar proportion of cytological abnormalities among women undergoing sporadic opportunistic testing and invited women was found. In multivariate analyses, younger age, being single or a social welfare recipient and residence region (North Denmark) were especially associated with opportunistic testing (routine or sporadic).


One fourth of cervical cytologies in this study were collected opportunistically. Compared to invited women, women undergoing routine opportunistic testing were more likely to be diagnosed with abnormal cytologies. Hence, routine opportunistic testing might serve as an important supplement to the systematic screening program by covering non-participating women who may otherwise be tested with a delay or not tested at all. Among women tested more often than recommended (sporadic testing), no benefits in terms of detecting more cytological abnormalities were identified.
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