To compare the effect of organised pap-smear screening for cervical cancer
with that of the spontaneous one on the incidence of invasive cervical canc
er, we performed a case-control study within the catchment area of the Hels
inki University Hospital (Helsinki, Finland). The study material consisted
of 179 incident cases of invasive cervical cancer and 1,507 population cont
rols. Data an lifetime pap smears before the year of the cancer diagnosis w
ere collected using a self-administered questionnaire. The questionnaire in
formation was obtained for 82% of the cases and 73% of the controls. The ma
in outcome measure was relative risk of invasive cervical cancer among thos
e with history of organised or spontaneous screening compared with risk amo
ng those with no history of screening for cervical cancer, measured as odds
ratios (OR) with 95% confidence intervals (CI) and computed with logistic
regression. Odds ratio of invasive cervical cancer among those who particip
ated in the organised screening programme was 0.38 (CI 0.26-0.56) whereas a
ny lifetime spontaneous pap smear had an OR value of 0.82 (CI 0.53-1.26), i
n terms of unit risk for those not subjected to any screening and adjusted
for age and the other type of the screening activity. Our results indicate
that the substantial decrease in the incidence of and mortality due to cerv
ical cancer in Finland is mainly due to the organised mass-screening. (C) 1
999 Wiley-Liss, Inc.