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Efficacy of screening in preventing cervical cancer among older women

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Abstract

Background

Although the effectiveness of cervical cancer screening has been firmly established in reproductive-age women, its usefulness in older women is unclear. We sought to evaluate the efficacy of cervical cancer screening in older women.

Methods

We conducted a case–control study within two integrated health care systems in the northwestern United States. Cases (n = 69) were women aged 55–79 years who were diagnosed with invasive cervical cancer during 1980–1999. Controls (n = 208) were women with an intact uterus and no diagnosis of cervical cancer, but otherwise similar to cases in terms of age and length of enrollment in the health plan. We reviewed medical records to ascertain screening history during the 7 years prior to reference date.

Results

Compared to cases, controls were more likely to have received a Pap test. After adjustment for age and current smoking status, screening prior to an estimated 1-year duration of the occult invasive phase of cervical cancer was associated with a substantial reduction in risk [odds ratio (OR) 0.23; 95 % CI 0.11–0.44]. Similar results were obtained using different estimates of the duration of the occult invasive phase. Analysis of the relative incidence of invasive cervical cancer in relation to the time following a negative screening test suggested a large reduction during the first year (OR 0.09; 95 % CI 0.03–0.24). The incidence remained low for several years thereafter, returning to the incidence among unscreened women after 5–7 years.

Conclusions

Cervical cancer screening by means of cytology is highly efficacious in older women. Our findings also suggest that five-yearly screening is approximately as efficacious as more frequent screening.

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References

  1. Cannistra SA, Niloff JM (1996) Cancer of the uterine cervix. N Engl J Med 334:1030–1038

    Article  PubMed  CAS  Google Scholar 

  2. Day NE (1984) Effect of cervical cancer screening in Scandinavia. Obstet Gynecol 63:714–718

    PubMed  CAS  Google Scholar 

  3. Parkin DM, Nguyen-Dinh X, Day NE (1985) The impact of screening on the incidence of cervical cancer in England and Wales. Br J Obstet Gynaecol 92:150–157

    Article  PubMed  CAS  Google Scholar 

  4. Gustafsson L, Adami HO (1990) Cytologic screening for cancer of the uterine cervix in Sweden evaluated by identification and simulation. Br J Cancer 61:903–908

    Article  PubMed  CAS  Google Scholar 

  5. Sigurdsson K (1993) Effect of organized screening on the risk of cervical cancer. Evaluation of screening activity in Iceland, 1964–1991. Int J Cancer 54:563–570

    Article  PubMed  CAS  Google Scholar 

  6. Celentano DD, Klassen AC, Weisman CS, Rosenshein NB (1988) Cervical cancer screening practices among older women: results from the Maryland cervical cancer case-control study. J Clin Epidemiol 41:531–541

    Article  PubMed  CAS  Google Scholar 

  7. Fletcher A (1990) Screening for cancer of the cervix in elderly women. Lancet 335:97–99

    Article  PubMed  CAS  Google Scholar 

  8. Van Wijngaarden WJ, Duncan ID (1993) Rationale for stopping cervical screening in women over 50. BMJ 306:967–971

    Article  PubMed  Google Scholar 

  9. Gustafsson L, Sparen P, Gustafsson M et al (1995) Low efficiency of cytologic screening for cancer in situ of the cervix in older women. Int J Cancer 63:804–809

    Article  PubMed  CAS  Google Scholar 

  10. Cruickshank ME, Angus V, Kelly M, McPhee S, Kitchener HC (1997) The case for stopping cervical screening at age 50. Br J Obstet Gynaecol 104:586–589

    Article  PubMed  CAS  Google Scholar 

  11. Sasieni P, Adams J, Cuzick J (2003) Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 89:88–93

    Article  PubMed  CAS  Google Scholar 

  12. Andrae B, Kemetli L, Sparen P et al (2008) Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst 100:622–629

    Article  PubMed  Google Scholar 

  13. Moyer VA, Force USPST (2012) Screening for cervical cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 156(880–91):W312

    Article  Google Scholar 

  14. Saslow D, Solomon D, Lawson HW et al (2012) American cancer society, American society for colposcopy and cervical pathology, and American society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 62:147–172

    Article  PubMed  Google Scholar 

  15. American Congress of Obstetricians and Gynecologists (ACOG) (2012) Practice Bulletin No. 131: screening for cervical cancer. Obstet Gynecol 120:1222–1238

  16. Surveillance Epidemiology and End Results. SEER Stat facts sheets: cervix uteri. [cited 2012 November 26]. Available from: http://seer.cancer.gov/statfacts/html/cervix.html#references

  17. Weiss NS (1999) Case-control studies of the efficacy of screening tests designed to prevent the incidence of cancer. Am J Epidemiol 149:1–4

    Article  PubMed  CAS  Google Scholar 

  18. Albert A, German PM, Louis TA (1978) Screening for the early detection of cancer. The temporal natural history of a progressive disease state. Math Biosci 40:1–59

    Article  Google Scholar 

  19. Coppleson LW, Brown B (1975) Observations on a model of the biology of carcinoma of the cervix: a poor fit between observation and theory. Am J Obstet Gynecol 122:127–136

    PubMed  CAS  Google Scholar 

  20. Brookmeyer R, Day NE (1987) Two-stage models for the analysis of cancer screening data. Biometrics 43:657–669

    Article  PubMed  CAS  Google Scholar 

  21. Albert A (1981) Estimated cervical cancer disease state incidence and transition rates. J Natl Cancer Inst 67:571–576

    PubMed  CAS  Google Scholar 

  22. Berrino F, Gatta G, d’Alto M, Crosignani P, Riboli E (1986) Efficacy of screening in preventing invasive cervical cancer: a case-control study in Milan, Italy. IARC Sci Publ 111–23

  23. IARC Working Group on Cervical Cancer Screening. Screening for squamous cervical cancer—the duration of low risk following negative results in cervical cytology test: introduction. IARC Sci Publ 1986:15–24

  24. Greenland S (1995) Dose-response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology 6:356–365

    Article  PubMed  CAS  Google Scholar 

  25. Schiffman MH, Brinton LA, Devesa SS, Fraumeni JF Jr (1996) Cervical cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, pp 1090–1116

    Google Scholar 

  26. Bosch FX, Munoz N, de Sanjose S et al (1992) Risk factors for cervical cancer in Colombia and Spain. Int J Cancer 52:750–758

    Article  PubMed  CAS  Google Scholar 

  27. Brinton LA, Hamman RF, Huggins GR et al (1987) Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst 79:23–30

    PubMed  CAS  Google Scholar 

  28. Kjaer SK, Dahl C, Engholm G, Bock JE, Lynge E, Jensen OM (1992) Case-control study of risk factors for cervical neoplasia in Denmark. II. Role of sexual activity, reproductive factors, and venereal infections. Cancer Causes Control 3:339–348

    Article  PubMed  CAS  Google Scholar 

  29. La Vecchia C, Franceschi S, Decarli A et al (1986) Sexual factors, venereal diseases, and the risk of intraepithelial and invasive cervical neoplasia. Cancer 58:935–941

    Article  PubMed  Google Scholar 

  30. Peters RK, Thomas D, Hagan DG, Mack TM, Henderson BE (1986) Risk factors for invasive cervical cancer among Latinas and non-Latinas in Los Angeles county. J Natl Cancer Inst 77:1063–1077

    PubMed  CAS  Google Scholar 

  31. Daling JR, Madeleine MM, McKnight B et al (1996) The relationship of human papillomavirus-related cervical tumors to cigarette smoking, oral contraceptive use, and prior herpes simplex virus type 2 infection. Cancer Epidemiol Biomarkers Prev 5:541–548

    PubMed  CAS  Google Scholar 

  32. Brinton LA, Fraumeni JF Jr (1986) Epidemiology of uterine cervical cancer. J Chronic Dis 39:1051–1065

    Article  PubMed  CAS  Google Scholar 

  33. Lyon JL, Gardner JW, West DW, Stanish WM, Hebertson RM (1983) Smoking and carcinoma in situ of the uterine cervix. Am J Public Health 73:558–562

    Article  PubMed  CAS  Google Scholar 

  34. Slattery ML, Robison LM, Schuman KL et al (1989) Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer. JAMA 261:1593–1598

    Article  PubMed  CAS  Google Scholar 

  35. Trevathan E, Layde P, Webster LA, Adams JB, Benigno BB, Ory H (1983) Cigarette smoking and dysplasia and carcinoma in situ of the uterine cervix. JAMA 250:499–502

    Article  PubMed  CAS  Google Scholar 

  36. Lonnberg S, Anttila A, Luostarinen T, Nieminen P (2012) Age-specific effectiveness of the finnish cervical cancer screening programme. Cancer Epidemiol Biomarkers Prev 21:1354–1361

    Article  PubMed  Google Scholar 

  37. Rebolj M, van Ballegooijen M, Lynge E et al (2009) Incidence of cervical cancer after several negative smear results by age 50: prospective observational study. BMJ 338:b1354

    Article  PubMed  Google Scholar 

  38. Herbert A, Breen C, Bryant TN et al (1996) Invasive cervical cancer in Southampton and South West Hampshire: effect of introducing a comprehensive screening programme. J Med Screen 3:23–28

    PubMed  CAS  Google Scholar 

  39. Surveillance Epidemiology and End Results. Fast Stats. [cited 2012 November 26]; Available from: http://seer.cancer.gov/faststats/selections.php?series=cancer

  40. American Cancer Society (2009) Cancer facts & figures 2009. Atlanta, American Cancer Society

    Google Scholar 

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Acknowledgments

This work was supported by the National Cancer Institute at the National Institutes of Health (Grants R03 CA84540 and R35 CA39779).

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None.

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Authors and Affiliations

  1. Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA

    Aruna Kamineni

  2. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Sheila Weinmann & Andrew G. Glass

  3. Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

    Kirkwood K. Shy

  4. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Noel S. Weiss

  5. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Noel S. Weiss

Authors
  1. Aruna Kamineni
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  2. Sheila Weinmann
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  3. Kirkwood K. Shy
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  4. Andrew G. Glass
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  5. Noel S. Weiss
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Corresponding author

Correspondence to Aruna Kamineni.

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Kamineni, A., Weinmann, S., Shy, K.K. et al. Efficacy of screening in preventing cervical cancer among older women. Cancer Causes Control 24, 1653–1660 (2013). https://doi.org/10.1007/s10552-013-0239-4

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  • DOI: https://doi.org/10.1007/s10552-013-0239-4

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