Abstract
In a series of 430,015 cervical smears made by general practitioners and coming from all regions of the Netherlands in the period 1972–1980, no significant changes were noted in the rates of positive smears (Papanicolaou IV and V). These data are especially relevant in deciding the age limits for the cytology health service programs. Women aged more than 55 years contribute only 5% of the smears made by house doctors; nevertheless, this group had just as many cases of invasive carcinoma as the younger group. Since 1974 there has been an increase in the diagnosis of adenocarcinoma in situ of the endocervix, probably due to better knowledge of the cytologic and histologic criteria of this lesion. The effects of under-diagnosis of this carcinoma precursor are stressed. It is concluded that it is more important at present to concentrate any additional cytological screening on the « forgotten group » of women aged over 55 years and not yet to extend health survey programs to women under 35 years. However, this policy may need to be reviewed if increased rates of preinvasive tumor in the future lead to an earlier average age for invasive tumor.
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