peer reviewed ; Objective Cervical cancer screening by surveys overestimate coverage because of selection and reporting biases. Methods The prepared Inter-Mutualistic Agency dataset has about 13 million records from Pap smears, colposcopies, cervical biopsies and surgery, performed in Belgium between 1996 and 2000. Cervical cancer screening coverage was defined as the proportion of the target population (women of 25–64 years) that has had a Pap smear taken within the last 3 years. Proportions and incidence rates were computed using official population data of the corresponding age group, area and calendar year. Results Cervical cancer screening coverage, in the period 1998–2000, was 59% at national level, for the target age group 25–64 years. Differences were small between the 3 regions. Variation ranged from 39% to 71%. Coverage was 64% for 25–29 year old women, 67% for those aged 30–39 years, 56% for those aged 50–54. The modal screening interval was 1 year. In the 3-year period 1998–2000, 3 million smears were taken from the 2.7 million women in the age group 25–64. Only 1.6 million women of the target group got one or more smears in that period and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman. Conclusion Coverage reached only 59%, but the number of smears used was sufficient to cover more than 100% of the target population. Structural reduction of overuse and extension of coverage is warranted.