Screening history of women with cervical cancer: a 6-year study in Aarhus, Denmark

Ingemann-Hansen, Ole; Lidang, Marianne; Niemann, Isa; Dinesen, Jakob; Baandrup, Ulrik; Svanholm, Hans; Petersen, Lone Kjeld

doi:10.1038/sj.bjc.6604293

Cited by 29 publications

(18 citation statements)

References 8 publications

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“…13 In the United States, where screening is opportunistic, the proportion of cervical cancer cases aged 16-90 years old with no previous screening has been reported to be as low as 2.2%-7%, 14,15 with an increase in the proportion of unscreened or insufficiently screened women with increasing age. 16 In Europe, studies have reported that 25%-40% of cervical cancer cases have never been screened prior to their diagnosis, [17][18][19] and similarly to the United States, older women are reportedly less likely to have been screened F I G U R E 3 Results of cervical cytology tests obtained prior to a diagnosis of cervical cancer in 377 ever-screened women compared to younger women 19,20 ; however, this trend has been reported to decline over calendar time, as more women may have had the opportunity to be screened. 13 The incidence and mortality rates of cervical cancer are high in older Danish women.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

et al. 2019

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The incidence and mortality of cervical cancer are high in Danish women aged 60 years and older who are about to exit the cervical cancer screening program. The present study aimed to describe the screening history in women ≥60 years old, diagnosed with cervical cancer in Denmark, 2009‐2013. We retrieved information on cases of cervical cancer and previous cervical cancer screening from national registries. During the study period, a total of 1907 women were diagnosed with cervical cancer, 574 (30.1%) of which were ≥60 years old. The majority of women were diagnosed with squamous cell carcinoma (73.7%) and advanced‐stage disease (ASD, ie, ≥FIGO IIB; 63.1%). The proportion of ASD increased with age, from 51.9% in women aged 60‐64% to 76.7% in women aged 75‐79. Among screened women (n = 377), 22.8% had a cervical cytology within 5 years of diagnosis, 73.3% of which were normal, and 45.1% were diagnosed with ASD. Women who had been sufficiently screened prior to screening exit (≥2 normal cytology test in the age interval 50‐59) accounted for 18.1%. Of note, 53.8% of the sufficiently screened women were diagnosed with ASD. Sufficiently screened women were less likely to be diagnosed with ASD compared to never‐screened women (53.8% vs 67.5%, P < 0.020), but no difference was observed between sufficiently and insufficiently screened women (53.8% vs 63.4%, P = 0.091). Our findings suggest that cancer in older women may occur due to insufficient screening prior to screening exit, a low sensitivity of screening, and premature screening exit.

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Section: Discussionmentioning

confidence: 99%

Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

et al. 2019

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“…Other countries with national coverage of health care have the advantage of linking their cancer data with screening histories through pathology databases or other screening registries, which is much more conducive to this type of data collection. [26][27][28][29] However, despite barriers and the intensive work, the abstractors were able to pull 1.5 records on average for the women in the study who had been seen.…”

Section: Discussionmentioning

confidence: 99%

Overview of Centers for Disease Control and Prevention's Case Investigation of Cervical Cancer Study

Benard

Greek

Jackson

et al. 2019

Journal of Women's Health

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Background: Despite advances in cervical cancer screening, a significant number of women in the United States have not received adequate screening. Studies have suggested that approximately half of the women who developed cervical cancer were not adequately screened. The Centers for Disease Control and Prevention (CDC) Case Investigation of Cervical Cancer (CICC) Study took a unique approach to reconstruct the time before a woman's cervical cancer diagnosis and understand the facilitators and barriers to screening and care. This article provides an overview of the study. Methods: This study included all cervical cancer survivors diagnosed with invasive cervical cancer aged 21 years and older in three U.S. states from 2014-2016. The study design consisted of three different data collection methods, including comprehensive registry data, a mailed survey, and medical chart abstraction. This overview compares the characteristics of cervical cancer survivors in the three states by study participation and eligibility status. Results: Registries identified 2,748 women diagnosed with invasive cervical cancer. Of these, 1,730 participants were eligible for participation, 28% (n = 481) enrolled in the study and 23% (n = 400) consented to the medical chart abstraction. Conclusion: The CICC Study is unique in that it addresses, with medical record verification, the medical history of woman 5 years before their cervical cancer diagnosis as well as provides information from the woman on her health care behaviors. This study provides data on a general population of cervical cancer survivors in three states that could be used to guide interventions to increase cervical cancer screening.

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“…This analysis revealed that part of the observed increase in CIN treatments derived from a county with a historically low compliance with follow‐up recommendations. In this county, about 35% of women with abnormal smears were not followed‐up according to the guidelines,34 and 26% of cervical cancer patients with recent abnormal findings were inadequately followed‐up 35. In 2006, a strategy aiming to facilitate the adherence to the follow‐up guidelines was introduced 34.…”

Section: Discussionmentioning

confidence: 99%

Frequency of cervical intraepithelial neoplasia treatment in a well‐screened population

Barken

Rebolj

Andersen

et al. 2011

Intl Journal of Cancer

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Treatment of cervical intraepithelial neoplasia (CIN) detectable at screening has helped reduce the incidence of cervical cancer, but has also led to overtreatment. The estimates of overtreatment have often focused on a particular grade of CIN or age group. The aim of this paper was to provide a nationwide population-based estimate of the frequency of CIN treatment per prevented cervical cancer case in a well-screened population. We retrieved the data from the Danish National Population, Patient, Health Insurance, Pathology, and Cancer Registers, and calculated annual age-standardized CIN treatment rates. We estimated the frequency of CIN treatment per prevented cervical cancer case by comparing the cumulative life-time risk of CIN treatment from 1996 onward, with the difference in the cumulative life-time risks of cervical cancer in the prescreening and the screening periods. Since 1996, more than 5,000 CIN treatments were undertaken annually in the population of about 2.2 million women aged 15-84 years, and at present 5.2 CIN treatments are undertaken per 1,000 women aged 20-49. About six women have undergone CIN treatment for each prevented cervical cancer. The frequency of CIN treatment increased after 2004 and at present almost eight women are treated per prevented cervical cancer case. Screening, though effective in reducing the incidence of cervical cancer, leads also to a considerable burden of CIN treatment. Future trends in CIN treatment should be closely monitored.Cervical intraepithelial neoplasia (CIN) can be detected at screening, so that its progression to cervical cancer can be stopped. 1 The burden of cervical cancer has decreased, because the introduction of screening in Europe and Northern America in the 1960's, with data from several long-standing cancer registers showing that the incidence rates in most of these countries have more than halved since then. 2 However, not all untreated CIN would progress to cancer, 3 and there is at present no reliable method to distinguish between progressing and nonprogressing CIN. As a consequence, the reduction in the burden of cervical cancer for some women has been achieved by treating nonprogressive CIN in other women, and CIN treatment may potentially lead to adverse obstetric outcomes. 4,5 Even for highgrade CIN such as CIN3, the proportion without progression to cancer appears to be substantial. For example, following an unethical experiment in New Zealand in 1965-1974, during which women diagnosed with carcinoma in situ were withheld adequate treatment, 31% of those with ''minimum disturbance'' of the lesion developed cervical cancer in the following 30 years. 6 In the currently well-screened women, CIN lesions are probably diagnosed at an earlier stage compared with the New Zealand experiment. Lesions detected earlier may be smaller and have a lower potential for

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Screening history of women with cervical cancer: a 6-year study in Aarhus, Denmark

Cited by 29 publications

References 8 publications

Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

Overview of Centers for Disease Control and Prevention's Case Investigation of Cervical Cancer Study

Frequency of cervical intraepithelial neoplasia treatment in a well‐screened population

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