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Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions.

Ibáñez R, Alejo M, Combalia N, Tarroch X, Autonell J, Codina L, Culubret M, Bosch FX, de Sanjosé S - Biomed Res Int (2015)

Bottom Line: FIGO II-IV cases were more common among older women (older than 60 years).Absence of prior screening history was extremely common among CC cases compared to controls.Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), Avenida Gran Vía 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.

ABSTRACT

Objective: Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000-2011.

Methods: 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%).

Results: History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2-5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2-4.5). FIGO II-IV cases were more common among older women (older than 60 years).

Conclusions: Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

No MeSH data available.


Related in: MedlinePlus

Distribution of FIGO stages by time since prior cytology.
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Related In: Results  -  Collection


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fig1: Distribution of FIGO stages by time since prior cytology.

Mentions: Age was strongly associated with FIGO stages (P < 0.05) (Table 4). Women aged less than 40 years were more likely to have a stage I CC while stages II–IV were more common among women aged 60 or more. Older women were less likely to have a prior cytology (82.9% and 79.2% in age groups of 60–69 and ≥70 years, resp.) or to have had a cervical cytology within an interval longer than 3 years. In the presence of a previous screening history, women younger than 40 years old were more likely to have an abnormal cytological result compared to older women (P = 0.05). Women with normal cytology were, on average, older than women with an abnormal cytology (54.6 versus 43.8 years, resp., P = 0.003). Most of the atypical squamous cell of undetermined significance (ASC-US), atypical squamous cells cannot exclude a high grade squamous intraepithelial lesion (ASC-H) and atypical glandular cells of undetermined significance (AGC) results were diagnosed in the group of women aged 40–49 years (33.3%) while the low grade squamous intraepithelial lesions (LSIL) results were mostly diagnosed in women younger than 40 years (85.7%). About half of the negative cytologies (56.7%) and 80% of the positive cytologies were performed within 3 years prior to CC diagnosis (P = 0.029) (data not shown). Among all cases, 12 were in women younger than 30 years of age. Of them, 66.7% did not have any previous cytology, nearly half of the cases (41.6%) were diagnosed in stage I, and four were ADC as histological type. Figure 1 shows the distribution of the time since previous cytology to cancer diagnosis by FIGO stages. Although the differences were not statistically significant, women without previous cytology were more likely to be diagnosed at more advanced stages.


Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions.

Ibáñez R, Alejo M, Combalia N, Tarroch X, Autonell J, Codina L, Culubret M, Bosch FX, de Sanjosé S - Biomed Res Int (2015)

Distribution of FIGO stages by time since prior cytology.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4477117&req=5

fig1: Distribution of FIGO stages by time since prior cytology.
Mentions: Age was strongly associated with FIGO stages (P < 0.05) (Table 4). Women aged less than 40 years were more likely to have a stage I CC while stages II–IV were more common among women aged 60 or more. Older women were less likely to have a prior cytology (82.9% and 79.2% in age groups of 60–69 and ≥70 years, resp.) or to have had a cervical cytology within an interval longer than 3 years. In the presence of a previous screening history, women younger than 40 years old were more likely to have an abnormal cytological result compared to older women (P = 0.05). Women with normal cytology were, on average, older than women with an abnormal cytology (54.6 versus 43.8 years, resp., P = 0.003). Most of the atypical squamous cell of undetermined significance (ASC-US), atypical squamous cells cannot exclude a high grade squamous intraepithelial lesion (ASC-H) and atypical glandular cells of undetermined significance (AGC) results were diagnosed in the group of women aged 40–49 years (33.3%) while the low grade squamous intraepithelial lesions (LSIL) results were mostly diagnosed in women younger than 40 years (85.7%). About half of the negative cytologies (56.7%) and 80% of the positive cytologies were performed within 3 years prior to CC diagnosis (P = 0.029) (data not shown). Among all cases, 12 were in women younger than 30 years of age. Of them, 66.7% did not have any previous cytology, nearly half of the cases (41.6%) were diagnosed in stage I, and four were ADC as histological type. Figure 1 shows the distribution of the time since previous cytology to cancer diagnosis by FIGO stages. Although the differences were not statistically significant, women without previous cytology were more likely to be diagnosed at more advanced stages.

Bottom Line: FIGO II-IV cases were more common among older women (older than 60 years).Absence of prior screening history was extremely common among CC cases compared to controls.Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), Avenida Gran Vía 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.

ABSTRACT

Objective: Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000-2011.

Methods: 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%).

Results: History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2-5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2-4.5). FIGO II-IV cases were more common among older women (older than 60 years).

Conclusions: Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

No MeSH data available.


Related in: MedlinePlus