Impact of opportunistic screening on squamous cell and adenocarcinoma of the cervix in Germany: A population-based case-control study

Abstract

Background We investigated the uptake of opportunistic cervical cancer screening (CCS) and other risk factors and their association with cervical cancer in Germany in a case-control study. Methods and findings We recruited incident cases of cervical cancer (ICD-10 C53) diagnosed between 2012 and 2016 and matched with three population-based controls, based on age and region of residence. Cases and controls reported their CCS participation during the past ten years (frequent: every three years; no or infrequent: less than every three years) and other relevant variables. We fitted conditional logistic regression models, reporting odds ratios (OR) and 95% confidence intervals (95% CI). We report overall and stratified analyses by histologic group (squamous cell–SCC, and adenocarcinoma–AC), T category (T1 and T2+), and age (<50 and ≥50 years). We analysed 217 cases and 652 matched controls. 53.0% of cases and 85.7% of controls attended CCS frequently. In the overall adjusted model, no or infrequent participation in CCS (OR 5.63; 95% CI 3.51 to 9.04), having had more than one sexual partner (OR 2.86; 95%CI 1.50 to 5.45) and obesity (OR 1.69; 95% CI 1.01 to 2.83) were associated with cervical cancer. Twelve years of schooling (OR 0.37; 95% CI 0.23 to 0.60) and a net monthly income of €3000 or more (OR 0.50; 95% CI 0.30 to 0.82) were protective factors. In the stratified analyses, no or infrequent participation was associated with T1 (OR 4.37; 95% CI 2.48 to 7.71), T2+ (OR 10.67; 95% CI 3.83 to 29.74), SCC (OR 6.88; 95% CI 4.08 to 11.59) and AC (OR 3.95; 95% CI 1.47 to 10.63). Conclusion Although women who frequently attended CCS were less likely to develop cervical cancer, especially larger tumours, the high proportion of cases who had been frequently screened prior to diagnosis underscores the need to investigate the quality of cytology and treatment of precancerous lesions in Germany.

Impact of screening on cervical cancer incidence and mortality in a Northern Brazilian city

“…In addition, it was noted that the main risk factors for the development of the disease were having early sexual intercourse, low education, multi-parity, promiscuity, smoking, continuous use of contraceptive pills and, especially, HPV infection [30].…”

Gastric-type mucinous endocervical adenocarcinomas: A case report and literature review

“…As early as 1988, a case–control study of 39 cases and 409 controls in the greater Milan region showed that the relative risk of cervical adenocarcinoma increased with the increase of the number of deliveries and abortions, the age of birth, and the age of first sexual intercourse ( Parazzini et al., 1988 ). The current analyses were based on data from the multicenter TeQaZ study, which shows that currently living with a partner, having at least four children, having had more than one sexual partner, ever smoking, and obesity were significantly associated with cervical cancer ( Tanaka et al., 2021 ). In our report, the patient has been pregnant eight times, including two cesarean sections and six abortions.…”

A tree‐based modeling approach for matched case‐control studies

“…For further illustration, in this section the proposed method is applied to a real data example. The data originate from the so‐called TeQaZ study, 27 a case‐control study on cervical cancer. The main focus of the study was to examine the effect of frequent participation in cervical cancer screening (CCS) on the risk of cervical cancer.…”

“…Table S1 (see supplementary materials) shows the list of variables contained in the corresponding data set. Tanaka et al 27 analyzed these data using CLR incorporated into a multiple imputation process. In contrast to this original analysis, we use only complete observations without any missings in the variables listed in Table S1.…”