Effects and Costs of Cervical Cancer Screening

The objective of this thesis is to evaluate cervical eaueer screening by assessing its various effects and costs. Questions to be addressed concern the rednetion in incidence and mortality, the unfavourablc effects and the cost-effectiveness of different screening polides (age range and interval combinations). To this end, we used acervical eaueer version of MISCAN, a simulation model that was designed and programmed to evaluate cancer screening. This cervical eaueer screening model. had already been tested against screening data sets from British Columbia (Canada) and from Dutch pilot screeningprojectsin 1976- 1985. The potential impact of new developments in cervical eaueer screening, such as auto~1ated cytological evaluation and HPV-testing, has been investigated. The ultimate questions are: should ccrvical caoeer screening be conti. nued, and what changes should be recommended in order to iinprove its efficiency? The relationship between benefits and unfavourable effects was stuclied for three efficient cervical cancer screening strategies incorporating 5, 10 and 25 smears per woman (Chapter 2). It was concluded that wlien the screening frequency was increased, the ratio of favourable to unfavourable effects became worse.

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