Introduction The Chilean Cervical Screening Programme (CCSP) was implemented nationally in 1994, but its performance and effectiveness in reducing mortality from cervical cancer (CC) have not been assessed at an individual level. This is the first comprehensive evaluation of a national screening programme in a developing country based on individual record-linkage.
Methods We linked three Chilean national datasets using the unique personal identification number: (1) the National Health Service (NHS) dataset, which holds data on all women registered in the public health sector; (2) the Cito-Expert dataset, which contains all NHS screening records; and (3) national data on underlying causes of all deaths. This linkage provided a retrospective cohort of 2.8 million women aged 25–64 years followed from 1997 to 2007. The CCSP was assessed in terms of its performance and effectiveness in reducing CC mortality.
Results About 30% of the women in the cohort were never screened during the study period in the public health sector. The 5-year coverage was ∼60%, with over-screening in specific subgroups, and ∼60–70% of LSIL+ smears had three following normal smears within 48 months. Women ever screened had a 30% reduction in CC mortality relative to those who had never been screened (adjusted rate ratio: 0.7, 95% CI 0.6 to 0.8). The effectiveness of the programme was higher in middle-aged women (35–54 years) and in the lowest socioeconomic group.
Discussion The CCSP has reduced CC mortality during the last decade, but its impact could be increased by improving coverage and follow-up of abnormal smears.
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