{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T15:06:21Z","timestamp":1770822381348,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2011,1,24]],"date-time":"2011-01-24T00:00:00Z","timestamp":1295827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cytopathology"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:p>S. L\u00f6nnberg, P. Nieminen, L. Kotaniemi\u2010Talonen, H. Kujari, J. Melkko, G. Granroth, M. Vornanen, T. Pietil\u00e4inen, J. Arola, J. Tarkkanen, T. Luostarinen and A. Anttila<\/jats:p><jats:p><jats:bold>Large performance variation does not affect outcome in the Finnish cervical cancer screening programme<\/jats:bold><\/jats:p><jats:p><jats:bold>Objective:\u2002<\/jats:bold> Cytology screening for prevention of cervical cancer can reduce incidence and mortality by more than 80% in settings with good organization and rigorous quality control. Audit studies are essential for reaching and maintaining a high quality of screening. The aim of this study was to evaluate variation in performance indicators by screening laboratory and assess the impact on the effectiveness of screening as indicated by cervical intraepithelial neoplasia grade 3 and above (CIN3+) rates after a negative screen.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> Seven cytology screening laboratories operating during 1990\u20131999 with a total of 953\u2003610 screening tests performed were included in the study. By linking screening and cancer register files, all cases of CIN3+ diagnosed in the screened population were identified. For 395 CIN3+ cases with a preceding negative screen and 787 controls, a re\u2010evaluation of smears was undertaken to uncover false negative screening tests. Performance parameters and rates of CIN3+ after a negative screen were analysed for interlaboratory heterogeneity.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> The rates of follow\u2010up recommendations and referrals varied by up to 3.6\u2010 (2.8\u201310.2%) and 4.0\u2010fold (0.03\u20130.12%), respectively. CIN1, CIN2 and CIN3+ screen detection rates differed by up to 8.5\u2010 (0.02\u20130.17%), 5.4\u2010 (0.05\u20130.25%) and 3.3\u2010fold (0.05\u20130.18%). False negative rates determined by re\u2010evaluation showed up to 2.1\u2010fold differences (29\u201362%). Rates of CIN3+ after a negative screen (0.023\u20130.048%) and as a proportion of total CIN3+ (15\u201331%) in the screened population were low and did not vary significantly.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> There were large variations in the sensitivity\u2013specificity trade\u2010off between laboratories, reflected in all performance indicators as well as in the test validity estimates of the re\u2010evaluation phase, but not in screening effectiveness. Even though performance variations do not always have an impact on the effectiveness of screening, they lead to variations in cost, treatment and psychological burden, and should be addressed.<\/jats:p>","DOI":"10.1111\/j.1365-2303.2011.00849.x","type":"journal-article","created":{"date-parts":[[2011,1,24]],"date-time":"2011-01-24T07:33:09Z","timestamp":1295854389000},"page":"172-180","source":"Crossref","is-referenced-by-count":4,"title":["Large performance variation does not affect outcome in the Finnish cervical cancer screening programme"],"prefix":"10.1111","volume":"23","author":[{"given":"S.","family":"L\u00f6nnberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Nieminen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Kotaniemi\u2010Talonen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Kujari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Melkko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Granroth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Vornanen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Pietil\u00e4inen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Arola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Tarkkanen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Luostarinen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Anttila","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,1,24]]},"reference":[{"key":"e_1_2_10_2_2","first-page":"11","volume-title":"European Guidelines for Quality Assurance in Cervical Cancer Screening","author":"Anttila A","year":"2008"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-09-1038"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.11.1500"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2303.1998.00220.x"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970825)81:4<212::AID-CNCR3>3.0.CO;2-R"},{"key":"e_1_2_10_7_2","first-page":"2093","article-title":"The annual number of pap smears and the reporting system used in Finland","volume":"18","author":"Monto K","year":"2005","journal-title":"Suomen L\u00e4\u00e4k\u00e4rilehti"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2007.12.002"},{"key":"e_1_2_10_9_2","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1093\/jnci\/djp367","article-title":"Age\u2010specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting","volume":"101","author":"Leinonen M","year":"2009","journal-title":"J Natl Cancer Inst"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1804"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-6-252"},{"key":"e_1_2_10_12_2","unstructured":"Finnish Cancer Registry [Internet]. 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