Background
Methods
Study population
Data sources
Cervical cytology
Sociodemography
Data handling
Categorisation of cervical cytology
Statistics
Cervical cytology diagnoses
Sociodemography
Ethics
Results
Sample characteristics
Variables | Screened after invitation1 | Routine opportunistic testing2 | Sporadic opportunistic testing3 | |||
---|---|---|---|---|---|---|
n = 514,833 | n = 149,778 | n = 58,590 | ||||
n | % | n | % | n | % | |
Age (years) | ||||||
23–28 | 104,488 | 20.3 | 36,357 | 24.3 | 10,417 | 17.8 |
29–34 | 93,912 | 18.2 | 36,896 | 24.6 | 13,004 | 22.2 |
35–42 | 158,989 | 30.9 | 44,098 | 29.4 | 18,280 | 31.2 |
43–49 | 157,444 | 30.6 | 32,427 | 21.7 | 16,889 | 28.8 |
Residential region | ||||||
North Denmark | 40,778 | 7.9 | 16,649 | 11.1 | 6,658 | 11.4 |
Central Denmark | 113,977 | 22.1 | 33,259 | 22.2 | 12,088 | 20.6 |
Region of Southern Denmark | 109,159 | 21.2 | 25,485 | 17.0 | 9,647 | 16.5 |
Capital Region of Denmark | 167,310 | 32.5 | 50,859 | 34.0 | 23,016 | 39.3 |
Region Sealand | 72,537 | 14.1 | 18,076 | 12.1 | 5,174 | 8.8 |
Ethnicity | ||||||
Danish | 464,711 | 90.3 | 129,550 | 86.5 | 52,621 | 89.8 |
Western immigrants | 18,739 | 3.6 | 8,032 | 5.4 | 1,887 | 3.2 |
Non-western immigrants | 19,910 | 3.9 | 6,585 | 4.4 | 2,011 | 3.4 |
Marital status | ||||||
Single | 125,215 | 24.3 | 44,120 | 29.5 | 16,965 | 29.0 |
Married/registered partnership | 260,265 | 50.6 | 65,625 | 43.8 | 27,702 | 47.3 |
Cohabitating | 100,092 | 19.4 | 34,782 | 23.2 | 12,347 | 21.1 |
Occupation | ||||||
Employed | 383,011 | 74.4 | 102,797 | 68.6 | 42,606 | 72.7 |
Self-employed/chief executive | 23,786 | 4.6 | 6,736 | 4.5 | 3,047 | 5.2 |
Unemployed/benefits4 | 41,633 | 8.1 | 14,547 | 9.7 | 5,607 | 9.6 |
Retired | 2 | 0.0 | NA | NA | NA | NA |
Social welfare recipients | 15,902 | 3.1 | 8,047 | 5.4 | 2,307 | 3.9 |
Other | 33,283 | 6.5 | 10,825 | 7.2 | 2,714 | 4.6 |
Education (years) | ||||||
≤10 | 89,436 | 17.4 | 28,750 | 19.2 | 10,278 | 17.5 |
11–15 | 213,607 | 41.5 | 54,818 | 36.6 | 22,267 | 38.0 |
>15 | 184,185 | 35.8 | 53,984 | 36.0 | 22,845 | 39.0 |
Cytological diagnosis
Screened after invitation1 | Routine opportunistic testing2 | Sporadic opportunistic testing3 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
n = 514,833 (71.2 %) | n = 149,778 (20.7 %) | n = 58,590 (8.1 %) | ||||||||
n | % | n | % | PPD % (95 % CI)4 | PPR (95 % CI)5 | n | % | PPD % (95 % CI)6 | PPR (95 % CI)7 | |
Cytological diagnosis | ||||||||||
Normal cells | 478,855 | (93.0) | 136,797 | (91.3) |
−1.7 (−1.87; −1.52)
|
0.98 (0.98;0.98)
| 53,866 | (91.9) |
−1.1 (−1.34; −0.86)
|
0.99 (0.99;0.99)
|
ASCUS | 10,868 | (2.1) | 3,674 | (2.5) | 0.4 (−0.17; 0.95) |
1.16 (1.12;1.21)
| 1,361 | (2.3) | 0.2 (−0.64;1.04) |
1.10 (1.04;1.16)
|
ASC-H | 2,175 | (0.4) | 846 | (0.6) | 0.2 (−0.38; 0.78) |
1.34 (1.24;1.45)
| 250 | (0.4) | 0.0 (−0.83; 0.83) | 1.01 (0.89;1.15) |
AGC | 634 | (0.1) | 236 | (0.2) | 0.1 (−0.52; 0.72) |
1.28 (1.10;1.49)
| 99 | (0.2) | 0.1 (−0.81; 1.01) |
1.37 (1.11;1.70)
|
LSIL | 7,857 | (1.5) | 2,760 | (1.8) | 0.3 (−0.26; 0.86) |
1.21 (1.16;1.26)
| 945 | (1.6) | 0.1 (−0.74; 0.94) | 1.06 (0.99;1.13) |
HSIL | 4,791 | (0.9) | 2,228 | (1.5) |
0.6 (0.03; 1.17)
|
1.60 (1.52;1.68)
| 408 | (0.7) | −0.2 (−1.05; 0.65) |
0.75 (0.68;0.83)
|
Carcinoma in situ + AIS | 106 | (0.02) | 45 | (0.03) | 0.01 (−0.56; 0.58) | 1.46 (1.00;2.07) | 14 | (0.02) | 0.0 (−0.79; 0.79) | 1.16 (0.66;2.03) |
Carcinoma8 | 42 | (0.01) | 42 | (0.03) | 0.02 (−0.58; 0.62) |
3.44 (2.24;5.27)
| 2 | (0.0) | −0.01 (−0.31; 0.29) | 0.42 (0.10;1.72) |
Inadequate cervical cytology9 | 9,109 | (1.8) | 2,988 | (2.0) | 0.2 (−0.37; 0.77) |
1.13 (1.08;1.17)
| 1,538 | (2.6) | 0.8 (−0.04; 1.64) |
1.48 (1.40;1.56)
|
Others10 | 29 | (0.01) | 8 | (0.01) | 0.0 (−0.78; 0.78) | 0.95 (0.43;2.07) | 1 | (0.0) | NA | NA |
Screened after invitation1 | Routine opportunistic testing2 | Sporadic opportunistic testing3 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
n/N4 | % | n/N5 | % | PPD % (95 % CI)6 | PPR (95 % CI)7 | n/N8 | % | PPD % (95 % CI)9 | PPR (95 % CI)10 | |
Cytological diagnosis | ||||||||||
Normal cells | ||||||||||
23-28 | 92,693/104,448 | (88.7) | 32,034/36,357 | (88.1) |
-0.6 (-1.0;-0.2)
| 0.99 (0.98;1.00) | 9,141/10,417 | (87.8) |
-0.6 (-1.6;-0.2)
| 0.99 (0.98;1.00) |
29-34 | 87,023/93,912 | (92.7) | 33,615/36,896 | (91.1) |
-1.6 (-2.0;-1.2)
| 0.98 (0.98;1.00) | 11,887/13,004 | (91.4) |
-1.3 (-1.8;-0.8)
| 0.99 (0.98;1.00) |
35-42 | 149,489/158,989 | (94.0) | 40,764/44,098 | (92.4) |
-1.6 (-1.9;-1.3)
|
0.98 (0.98;0.99)
| 16,960/18,280 | (92.8) |
-1.2 (-1.6;-0.8)
|
0.99 (0.98;0.99)
|
43-49 | 149,650/157,444 | (95.0) | 30,384/32,427 | (93.7) |
-1.3 (-1.6;-1.0)
|
0.99 (0.98;0.99)
| 15,878/16,889 | (94.0) |
-1.0 (-1.4;-0.6)
| 0.98 (0.99;1.00) |
HSIL | ||||||||||
23-28 | 1,762/104,448 | (1.7) | 778/36,357 | (2.1) | 0.4 (-0.8;1.6) |
1.27 (1.17;1.38)
| 156/10,417 | (1.5) | -0.2 (-2.2;1.8) | 0.89 (0.75;1.04) |
29-34 | 1,217/93,912 | (1.3) | 631/36,896 | (1.7) | 0.4 (-0.8;1.6) |
1.26 (1.15;1.39)
| 105/13,004 | (0.8) | -0.5 (-0.2;1.3) |
0.59 (0.49;0.73)
|
35-42 | 1,242/158,989 | (0.8) | 552/44,098 | (1.3) | 0.5 (-0.6;1.6) |
1.60 (1.45;1.77)
| 89/18,280 | (0.5) | -0.3 (-1.8;1.2) |
0.62 (0.50;0.77)
|
43-49 | 570/157,444 | (0.4) | 267/32,427 | (0.8) | 0.4 (-0.8;1.6) |
2.27 (1.97;2.63)
| 58/16,889 | (0.3) | -0.1 (-1.6;1.4) | 0.95 (0.72;1.24) |
Carcinoma in situ + AIS | ||||||||||
23-28 | 22/104,448 | (0.02) | 8/36,357 | (0.02) | 0.0 (-1.4;1.4) | 1.05 (0.47;2.35) | 2/10,417 | (0.02) | 0.0 (-2.0;2.0) | 0.91 (0.21;3.88) |
29-34 | 30/93,912 | (0.03) | 19/36,896 | (0.05) | 0.02 (-1.2;1.2) | 1.61 (0.91;2.86) | 5/13,004 | (0.04) | 0.01 (-1.8;1.9) | 1.20 (0.47;3.10) |
35-42 | 37/158,989 | (0.02) | 15/44,098 | (0.03) | 0.01 (-0.9;0.9) | 1.46 (0.80;2.66) | 6/18,280 | (0.03) | 0.01 (-1.4;1.4) | 1.41 (0.60;3.34) |
43-49 | 17/157,444 | (0.01) | 3/32,427 | (0.01) | 0.0 (-1.2;1.2) | 0.86 (0.25;2.92) | 1/16,889 | (0.01) | NA | 0.55 (0.07;4.12) |
Carcinoma11 | ||||||||||
23-28 | 4/104,448 | (0.00) | 3/36,357 | (0.01) | 0.01 (-1.1;1.1) | 2.16 (0.48;9.63) | 1/10,417 | (0.01) | NA | 2.51 (0.28;22.4) |
29-34 | 9/93,912 | (0.01) | 6/36,896 | (0.02) | 0.01 (-1.2;1.3) | 1.70 (0.60;4.77) | 0/13,004 | (0.00) | NA | NA |
35-42 | 17/158,989 | (0.01) | 20/44,098 | (0.05) | 0.04 (-1.0;1.1) |
4.18 (2.19;7.99)
| 0/18,280 | (0.00) | NA | NA |
43-49 | 12/157,444 | (0.01) | 13/32,427 | (0.04) | 0.03 (-1.2;1.3) |
5.26 (2.40;11.5)
| 1/16,889 | (0.01) | NA | 0.78 (0.10;5.97) |
Sensitivity analysis
Sociodemography and opportunistic testing
Routine opportunistic testing1 vs. screened after invitation3 | Sporadic opportunistic testing2 vs. screened after invitation3 | |||
---|---|---|---|---|
Unadjusted | Adjusted | Unadjusted | Adjusted | |
OR (95 % CI) | OR (95 % CI) | OR (95 % CI) | OR (95 % CI) | |
Age (years) | ||||
23–28 | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
29–34 |
1.13 (1.11–1.15)
| 1.02 (1.00–1.04) |
1.39 (1.35–1.43)
|
1.17 (1.13–1.20)
|
35–42 |
0.80 (0.78–0.81)
|
0.75 (0.73–0.76)
|
1.15 (1.12–1.18)
|
0.98 (0.95–1.00)
|
43–49 |
0.59 (0.58–0.60)
|
0.55 (0.54–0.56)
|
1.08 (1.05–1.10)
|
0.91 (0.89–0.94)
|
Residential region | ||||
Southern Denmark | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
North Denmark |
1.75 (1.71–1.79)
|
1.81 (1.77–1.85)
|
1.85 (1.79–1.91)
|
1.88 (1.82–1.95)
|
Central Denmark |
1.25 (1.23–1.27)
|
1.25 (1.23–1.28)
|
1.20 (1.17–1.23)
|
1.21 (1.18–1.25)
|
Capital Region of Denmark |
1.30 (1.28–1.32)
|
1.25 (1.22–1.27)
|
1.56 (1.52–1.60)
|
1.55 (1.51–1.59)
|
Region Sealand |
1.07 (1.05–1.09)
|
1.10 (1.07–1.12)
|
0.81 (0.78–0.84)
|
0.80 (0.77–0.83)
|
Ethnicity | ||||
Danish | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
Western immigrants |
1.54 (1.49–1.58)
|
1.25 (1.21–1.30)
|
0.89 (0.85–0.93)
| 1.00 (0.95–1.06) |
Non-western immigrants |
1.19 (1.15–1.22)
|
1.08 (1.05–1.12)
|
0.89 (0.85–0.93)
| 1.01 (0.96–1.07) |
Marital status | ||||
Single |
1.38 (1.36–1.40)
|
1.22 (1.20–1.23)
|
1.16 (1.13–1.19)
|
1.20 (1.17–1.23)
|
Married/registered partnership | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
Cohabiting |
1.40 (1.38–1.42)
|
1.16 (1.14–1.18)
|
1.27 (1.25–1.30)
|
1.10 (1.08–1.13)
|
Occupation | ||||
Employed | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
Self-employed/chief executive |
1.06 (1.03–1.09)
|
1.15 (1.11–1.18)
|
1.15 (1.11–1.20)
|
1.14 (1.10–1.19)
|
Unemployed/benefits4 |
1.30 (1.28–1.33)
|
1.27 (1.25–1.30)
|
1.21 (1.18–1.25)
|
1.21 (1.17–1.25)
|
Retired | NA | NA | NA | NA |
Social welfare recipients |
1.89 (1.83–1.94)
|
1.68 (1.63–1.73)
|
1.30 (1.25–1.36)
|
1.31 (1.24–1.37)
|
Other |
1.21 (1.18–1.24)
|
1.12 (1.09–1.15)
|
0.73 (0.70–0.76)
|
0.85 (0.82–0.89)
|
Education (years) | ||||
≤10 |
1.25 (1.23–1.27)
|
1.12 (1.10–1.14)
|
1.10 (1.08–1.13)
| 1.02 (1.00–1.05) |
11–15 | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
>15 |
1.14 (1.13–1.16)
|
1.07 (1.05–1.08)
|
1.19 (1.17–1.21)
|
1.07 (1.05–1.10)
|