Cervical cancer screening in Belgium

A description is given of the burden of cervical cancer and the status of s creening in Belgium until 1998. Screening is essentially opportunistic and generally performed at yearly intervals. A programme for organised screenin g - promoting one cervical smear every 3 years for women aged between 25 an d 64 years - is being set up in the Flemish Region alone. Important progres s has been made concerning the development of technical guidelines on the c ollection of an adequate Papanicolaou (Pap) smear, uniform terminology for the cytological report and the follow-up of positive tests. The implementat ion of the programme is confined to the provinces that :are instructed to m ake women and physicians aware of the screening policy. The establishment o f a screening register, allowing for individualised invitation of women, wa s hampered by strict privacy laws and by the heterogeneity of software used for data entry in cytological laboratories. The impact of the Flemish prog ramme was further limited since the reimbursement of smear taking by a gyna ecologist or a general practitioner (GP) and the cytological reading are no t conditioned by the respect of guidelines. This is due to the fact that th e organisation of preventive healthcare and the financing of medical activi ties concerns distinct authorities;. The coverage of the target population is good in Flanders (82.3% according to certain estimates), but is achieved at the expense of an important amount of over-screening. The coverage is l ower in the Walloon and the Capital Region. Rationalisation of the policy r egarding cancer screening involving all concerned authorities of the countr y is necessary. (C) 2000 Elsevier Science Ltd. All rights reserved.