Cervical cancer screening in Belgium
Introduction
An overview is given of the burden of cervical cancer and the organisation of screening in Belgium. In order to understand the important differences between the south and the north, it is useful to introduce briefly the federal structure of the country. This article deals mainly with the Flemish situation at the end of 1998. Less information is available on the two other regions.
Belgium has a very complex political structure. It is divided into three geographically separated regions: the Flemish Region (female population of 3.0 million), the Walloon Region (1.7 million women) and the Capital Region of Brussels (0.5 million women) (see Fig. 1). Another administrative layer, based on linguistic criteria, is superimposed on this: the Flemish, the French and the German community. The Capital of Brussels belongs to both the Flemish and French communities. The heterogeneous repartition of administrative responsibilities complicates decision-making in sectors such as social affairs and public health.
The organisation of preventive healthcare in Belgium is, since the state reform in 1980, confined to the communities, while curative care remains a national matter. A formal cervical cancer screening programme, based on the European guidelines, currently exists only in the Flemish community. It is not applied in the Brussels Region.
Periodical screening by specialised mobile teams or in fixed centres has been organised since 1965. This vertical system was abandoned in the beginning of the 1980s because of low attendance. Meanwhile, opportunistic screening, by private gynaecologists and to a lesser degree by general practitioners (GPs), has gradually increased.
In 1994, the Flemish Government decided to re-orientate the organisation of secondary prevention of cervical cancer according to the European guidelines [1]. Since then, early detection of cervical cancer is evolving from strictly opportunistic to more organised screening.
Section snippets
Incidence
In 1993, the National Cancer Register (NCR) reported 749 cases of cervical cancer of which 482 (64%) cases occurred in the Flemish Region, 206 (28%) in the Walloon Region and 61 (8%) in Brussels. The crude rate is 14.5 cases per 100 000 women-years for the whole of Belgium. The annual age-standardised rate, based on the world reference population, is 10.8/105 women. Cervical cancer ranks third after breast and colon cancer. The cumulative incidence between 0 and 74 years is 1.02%. The incidence
Aims
The general principles, formulated in the European Guidelines on Quality Assurance in Cervical Cancer Screening [1] form the basis of the Flemish programme. It targets almost 1.6 million women between 25 and 64 years old, residing in the Flemish Region. Nine and a half per cent (9.5%, 95% confidence interval: CI 8.9–11.3) of the Flemish female population in the age group 25–64 years underwent a total hysterectomy [7]. This proportion should be subtracted from the total population. Women
Situation in the south of Belgium
In 1992, a broad consensus on cervical cancer screening was accepted by the cancer detection centres of the French-speaking universities and confirmed by the concerned professional scientific societies [18]. The European guidelines and the Flemish instructions on uniform cytological interpretation and follow-up are generally agreed upon. The definition of the target age group is somewhat different. It is proposed that Pap smear screening should begin 3 years after initiation of sexual contact.
Discussion and conclusions
Opportunistic screening is still dominant in all Regions of Belgium. In Flanders, an organised screening programme according to the European recommendations is being established. Nevertheless, the evolution to a more organised approach is slow, as it depends upon the voluntary adaptation of professional behaviour of physicians, which is not always evident in a liberally organised healthcare system. A relatively high coverage rate of the target population has already been achieved, but at the
Acknowledgements
The project received financial support from the European Commission (Contract grant sponsor: European Union, Commission of the European Communities, Directorate-General for Employment, Industrial Relations and Social Affairs; Contract grant number: SOC 97 201143).
Neither the European Commission nor any person acting on its behalf is liable for any use made of this information.
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