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A primary healthcare based intervention to improve a Danish cervical cancer screening program - a cluster randomised controlled trial
  1. Henry Jensen, MR1,
  2. Hans Svanholm2,
  3. Henrik Stoevring3,
  4. Flemming Bro4
  1. 1 Region Midtjylland, Denmark;
  2. 2 Institute of Pathology, Regional Hospital Randers, Denmark;
  3. 3 Research Unit for General Practice in Odense, Denmark;
  4. 4 Research Unit for General Practice in Aarhus, Denmark
  1. E-mail: henryjensen.aarhus{at}


Study objective: To evaluate if a targeted invitation to women not participating for the last five years in cervical screening would decrease the number of these women, and if increasing general practitioners’ attention to the screening program for cervical cancer would increase participation.

Design: A cluster randomized controlled trial. We randomised at GP level all women enlisted at the GP’s. Regardless of group allocation all women received normal invitation. We additionally visited the practices to facilitate quality enhancements of the screening program for cervical cancer, combined with a special targeted invitation to women aged 23-59 enrolled at the general practices, who had not had a smear test for the last five years.

Settings: County of Aarhus, Denmark.

Participants: 117,129 women enrolled at 190 general practices.

Outcomes: Main outcome was proportion of non-attenders and secondary outcome was coverage rate.

Main results: A total of 1,737 non-attenders had a PAP-smear during follow-up. The decline of non-attenders was 0.87 % (95%CI: 0.57;1.16) after nine months in favour of the intervention.

A difference of 0.94 (95%CI: 0.21;1.67) in the change of coverage rate was observed at six months which increased to 1.97 % (95%CI: 0.03;3.91) at nine months in favour of the intervention.

Conclusion: It is possible to decrease the proportion of non-attenders and increase the coverage rate in a screening programme for cervical cancer using a special targeted invitation to non-attenders combined with a visit to general practitioners. To further improve the participation other barriers must be identified and addressed.

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