Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program.
Adult
Aged
Benchmarking
/ statistics & numerical data
Case-Control Studies
Cervix Uteri
/ pathology
Early Detection of Cancer
/ statistics & numerical data
Female
Humans
Mass Screening
/ organization & administration
Medical Audit
/ statistics & numerical data
Middle Aged
Papanicolaou Test
/ statistics & numerical data
Patient Participation
/ statistics & numerical data
Pregnancy
Program Evaluation
Registries
/ statistics & numerical data
Risk Assessment
Sweden
/ epidemiology
Uterine Cervical Neoplasms
/ diagnosis
Young Adult
cervical cancer
cervical screening
cytology
prevention
Journal
International journal of cancer
ISSN: 1097-0215
Titre abrégé: Int J Cancer
Pays: United States
ID NLM: 0042124
Informations de publication
Date de publication:
01 03 2020
01 03 2020
Historique:
received:
21
11
2018
revised:
26
04
2019
accepted:
30
04
2019
pubmed:
21
5
2019
medline:
15
2
2020
entrez:
21
5
2019
Statut:
ppublish
Résumé
Our study used a refined case-control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular-participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register-based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002-2011, and 30 population-based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8-4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5-1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2-5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice.
Identifiants
pubmed: 31107987
doi: 10.1002/ijc.32416
pmc: PMC7003887
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1230-1240Informations de copyright
© 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
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