Quality assurance in cervical cancer screening: the Icelandic experience 1964-1993

Monitoring of the effectiveness of a screening programme is vital to ensure optimal use of public resources. This report correlates the results of the Icelandic cervical cancer screening programme with the results of monitoring the programme since 1964. Screening has significantly decreased both the incidence and mortality rates and greatly affected the stage distribution of squamous cell carcinomas, but not of adeno- and adenosquamous carcinomas. In the 25-64 years age group, 84% were screened, 80% of whom were in the organised screening. Smears taken outside the guidelines amounted to 10%. Sensitivity at 1 year was 93% for all smears. At 3 years it was 81% for squamous cell carcinomas, and 42% for adeno-and adenosquamous carcinomas. The rate of unsatisfactory smears was 1.3% for all smears, and 4.5% of the women had abnormal smears (7.7% in the 20-24 years age group). The specificity of the smears test was 98%. It is concluded that monitoring is vital for optimal screening results and although screening is effective in the targeted age group of 25-64 years it should preferably start sooner after age 20 years with a screening interval of 2-3 years.