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Do women >or=50 years of age need as much screening as women <50 years after they have had negative screening results?

Armaroli P, Gallo F, Bellomi A, Ciatto S, Consonni D, Davi D, Giorgi-Rossi P, Iossa A, Mancini E, Naldoni C, Polla E, Ronco G, Serafini M, Vergini V, Zanier L, Zappa M, Segnan N - Br. J. Cancer (2008)

Bottom Line: Detection rate is significantly lower over 50 years of age.Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35).Benefits arising from cytological screening is uncertain in well-screened older women.

View Article: PubMed Central - PubMed

Affiliation: SCDO Epidemiologia dei Tumori, Centro Prevenzione Oncologica Regione Piemonte and Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, V. San Francesco da Paola 31, Torino 10123, Italy.

ABSTRACT
To assess the adequacy of a routine screening to identify cervical intraepithelial neoplasia 2 or worse (CIN2+) in women over 50 years of age, a retrospective cohort was set in six Italian organised population-based screening programmes. In all, 287 330 women (1 714 550 person-years of observation, 1110 cases) screened at age 25-64, with at least two cytological screening tests, the first negative, were followed from their first negative smear until a biopsy proven CIN2+ lesion or their last negative smear. For women aged 25-49 and 50-64 years, crude and age-standardised detection rate (DR), cumulative risk (CR), adjusted hazard risk for number of previous negative screens, probability of false-positive CIN2+ after two or more smear tests were calculated. Detection rate is significantly lower over 50 years of age. Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35). The CR of CIN2+ is at least eightfold higher in women <50 (CR=2.06, 95% CI: 1.88-2.23) after one previous negative test than in women >or=50 years with four screens (CR=0.23, 95% CI: 0.00-0.46). Over 50 years of age, after four tests at least three false-positive cases are diagnosed for every true positive. Benefits arising from cytological screening is uncertain in well-screened older women.

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Related in: MedlinePlus

Detection rate (per 10−4 person-years) of CIN2+ by age class.
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fig1: Detection rate (per 10−4 person-years) of CIN2+ by age class.

Mentions: Cervical intraepithelial neoplasia 2+ DR (Table 2, Figure 1) was most frequent among 25- to 29-year-old women (DR=14.11, 95% CI: 12.30–16.18 per 10 000 person-years), and a statistically significant decreasing trend (Score test for trend of rates: P-value<0.0001) was observed with increasing age, the lowest DR being observed in the 50–54 (DR=2.28, 95% CI: 1.76–2.96) and in the 60–64 (DR=2.43, 95% CI: 1.85–3.19) age groups. Detection rate is rather stable (around 2 per 10 000 person-years) and significantly lower over 50 years of age.


Do women >or=50 years of age need as much screening as women <50 years after they have had negative screening results?

Armaroli P, Gallo F, Bellomi A, Ciatto S, Consonni D, Davi D, Giorgi-Rossi P, Iossa A, Mancini E, Naldoni C, Polla E, Ronco G, Serafini M, Vergini V, Zanier L, Zappa M, Segnan N - Br. J. Cancer (2008)

Detection rate (per 10−4 person-years) of CIN2+ by age class.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480977&req=5

fig1: Detection rate (per 10−4 person-years) of CIN2+ by age class.
Mentions: Cervical intraepithelial neoplasia 2+ DR (Table 2, Figure 1) was most frequent among 25- to 29-year-old women (DR=14.11, 95% CI: 12.30–16.18 per 10 000 person-years), and a statistically significant decreasing trend (Score test for trend of rates: P-value<0.0001) was observed with increasing age, the lowest DR being observed in the 50–54 (DR=2.28, 95% CI: 1.76–2.96) and in the 60–64 (DR=2.43, 95% CI: 1.85–3.19) age groups. Detection rate is rather stable (around 2 per 10 000 person-years) and significantly lower over 50 years of age.

Bottom Line: Detection rate is significantly lower over 50 years of age.Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35).Benefits arising from cytological screening is uncertain in well-screened older women.

View Article: PubMed Central - PubMed

Affiliation: SCDO Epidemiologia dei Tumori, Centro Prevenzione Oncologica Regione Piemonte and Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, V. San Francesco da Paola 31, Torino 10123, Italy.

ABSTRACT
To assess the adequacy of a routine screening to identify cervical intraepithelial neoplasia 2 or worse (CIN2+) in women over 50 years of age, a retrospective cohort was set in six Italian organised population-based screening programmes. In all, 287 330 women (1 714 550 person-years of observation, 1110 cases) screened at age 25-64, with at least two cytological screening tests, the first negative, were followed from their first negative smear until a biopsy proven CIN2+ lesion or their last negative smear. For women aged 25-49 and 50-64 years, crude and age-standardised detection rate (DR), cumulative risk (CR), adjusted hazard risk for number of previous negative screens, probability of false-positive CIN2+ after two or more smear tests were calculated. Detection rate is significantly lower over 50 years of age. Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35). The CR of CIN2+ is at least eightfold higher in women <50 (CR=2.06, 95% CI: 1.88-2.23) after one previous negative test than in women >or=50 years with four screens (CR=0.23, 95% CI: 0.00-0.46). Over 50 years of age, after four tests at least three false-positive cases are diagnosed for every true positive. Benefits arising from cytological screening is uncertain in well-screened older women.

Show MeSH
Related in: MedlinePlus