Use of pap‐smears in a population without a mass screening program

Forsmo, Siri; Buhaug, Harald; Stalsberg, Helge

doi:10.3109/00016349409072513

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…Reliable information about patients' delay is not available in our study; and to our knowledge, no other studies have related patients' delay to parity. Since it is known that cervical cytologic examinations are often performed during family planning consultations and in relation to antenatal care,31 and that unmarried women have a lower attendance rate,32 it is possible that there is a decreased attendance in gynecologic examinations among nulliparous women in general. It has been reported that patients having regular check‐ups have a significantly lower delay 33.…”

Section: Discussionmentioning

confidence: 99%

Poorer survival of nulliparous women with endometrial carcinoma

Salvesen

Akslen

Albrektsen

et al. 1998

Cancer

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between parity and the incidence of endometrial carcinoma. A prognostic influence of reproductive factors has been reported for carcinomas of the breast and uterine follow-up information. RESULTS.Nulliparous women had a poorer 5-year survival rate compared with patients who had had 1 or more deliveries (57% vs. 81%, P Å 0.0001), and they were significantly older and had more advanced disease at the time of primary surgery than the parous women. After adjustment for traditional risk factors, a hazard ratio of 2.81 (95% confidence interval, 1.55-5.06) was found for nulliparous versus parous women. International Federation of Gynecology and Obstetrics stage, curative treatment, and tumor differentiation grade were also identified as independent prognostic factors, whereas age and menopausal status had prognostic significance in the univariate analysis only. CONCLUSIONS.The decreased survival among nulliparous women reported herein may reflect biologic differences between parous and nulliparous endometrial carcinoma patients. It may also be due in part to a greater delay in diagnosing the women in the nulliparous group.

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Section: Discussionmentioning

confidence: 99%

Poorer survival of nulliparous women with endometrial carcinoma

Salvesen

Akslen

Albrektsen

et al. 1998

Cancer

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“…However, these observations did not lead to early establishment of an organised screening programme, even though such programmes were developed in neighbouring Nordic countries during the 1960s and 1970s . In Norway, cytology became widespread during the 1970s, but without centralised management, the opportunistic screening activity was not optimally allocated in the target population . After a pilot in two counties in 1992–1994, the nationally organised population‐based programme was launched in 1995 with centralised monitoring, management functions and individual reminders to those overdue for their screening tests .…”

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confidence: 99%

“…9 In Norway, cytology became widespread during the 1970s, but without centralised management, the opportunistic screening activity was not optimally allocated in the target population. 10,11 After a pilot in two counties in 1992-1994, the nationally organised population-based programme was launched in 1995 with centralised monitoring, management functions and individual reminders to those overdue for their screening tests. 12 Organising the screening activity has led to a more efficient use of resources and further reductions in cervical cancer incidence and mortality.…”

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confidence: 99%

Cervical cancer prevented by screening: Long‐term incidence trends by morphology in Norway

Lönnberg

Hansen

Haldorsen

et al. 2015

Intl Journal of Cancer

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Both major morphologic types of cervical cancer, squamous cell carcinoma (SCC) and adenocarcinoma (AC), are causally related to persistent infection with high-risk human papillomavirus (hrHPV), but screening has primarily been effective at preventing SCC. We analysed incidence trends of cervical cancer in Norway stratified by morphologies over 55 years, and projected SCC incidence in the absence of screening by assessing the changes in the incidence rate of AC. The Cancer Registry of Norway was used to identify all 19,530 malignancies in the cervix diagnosed in the period 1956-2010. The majority of these (82.9%) were classified as SCCs, 10.5% as ACs and the remaining 6.6% were of other or undefined morphology. By jointpoint analyses of a period of more than five decades, the average annual percentage change in the age-standardised incidence was 21.0 (95%CI: 22.1-0.1) for cervical SCC, 1.5 (95%CI:1.1-1.9) for cervical AC and 20.9 (95%CI: 21.4 to 20.3) for cervical cancers of other or undefined morphology. The projected age-standardised incidence rate of cervical SCC in Norway, assuming no screening, was 28.6 per 100,000 woman-years in 2010, which compared with the observed SCC rate of 7.3 corresponds to an estimated 74% reduction in SCC or a 68% reduction due to screening in the total cervical cancer burden. Cytology screening has impacted cervical cancer burden more than suggested by the overall observed cervical cancer incidence reduction since its peak in the mid-1970s. The simultaneous substantial increase in cervical adenocarcinoma in Norway is presumably indicative of an increase in exposure to HPV over time.Cervical cancer burden peaked in the 1970s in Norway, and a reduction exceeding 50% in both incidence and mortality has since been observed. 1 Trends in the population burden of disease are driven by a composite of risk factor exposure in successive cohorts, changes in the age structure of the population, and the effectiveness of preventive measures over time. In the case of cervical cancer, risk is dominated by high-risk human papillomavirus (hrHPV) exposure and secondary prevention of invasive disease by screening for treatable precursors. The two main histological types of cervical cancer, squamous cell carcinoma (SCC) and adenocarcinoma (AC), share the necessary cause of persistent hrHPV infection, 2 but screening by cytology has mainly been effective at preventing SCC.3-5 Thus, historical trends in AC have been affected by screening to a much smaller degree and can arguably be considered to reflect the background risk of exposure to hrHPV. Other, rarer histological types of cervical cancer include adenosquamous carcinomas, other specified and unspecified carcinomas, very rare stromal, lymphoid and myeloid malignancies and melanomas. 6 There is some evidence suggesting that the effect of screening on adenosquamous carcinomas can be similar in magnitude to the effect on SCC, 7 but documentation of effect on the even rarer types of carcinomas is scarce. The occasional nonepithelial cervical cancers ar...

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“…During the period 1965-85, however, a 10-fold increase in the annual number of Pap smears was observed (Norges Offentlige Utredninger, 1987). This was due mainly to frequent opportunistic Pap testing, especially of women of child-bearing age (Forsmo et al, 1994). In most of the other Nordic countries, organized screening was introduced about 30 years ago, and cervical-cancer incidence has been decreasing since the mid-1960s (Hakama, 1982).…”

mentioning

confidence: 99%

Treatment of pre-invasive conditions during opportunistic screening and its effectiveness on cervical cancer incidence in one Norwegian county

Forsmo¹,

Buhaug²,

Skjeldestad

et al. 1997

Int. J. Cancer

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Norway had until recently no organized screening programme for cervical cancer, but opportunistic screening was common. This study focuses on the effectiveness of treatment of pre-malignant cervical conditions (CIN III) on cervicalcancer incidence in the county of Sør-Trøndelag in Norway, prior to the introduction of organized mass screening. The study is based on cervical-cancer incidence rates during the years 1965-92 and treatment data for CIN III. The expected number of cervical-cancer cases prevented due to early intervention was expressed in a regression model with 2 unknown parameters: the probability, p, of cancer development in case of CIN III, and the time lag, t, between treatment and when clinical cancer would otherwise have been diagnosed. The estimated probability that a patient treated for CIN III would have developed cervical cancer if not treated was found to be approximately 20%, and the mean time delay was around 16 years. In the last period of study (1988-92), the incidence was reduced by nearly 40% of what would have been expected without early intervention. Based on equal treatment rates as in 1990, parameter estimates were used to predict future incidence reduction. Maximum effectiveness will be achieved around the year 2005, with a nearly 70% reduction. Opportunistic screening and treatment of CIN III seems to have had considerable influence on cervical-cancer incidence. The costs, however, are substantial over-treatment, since our results indicate that 4 of 5 women treated for CIN III would not progress into the invasive state. Int.

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Use of pap‐smears in a population without a mass screening program

Cited by 9 publications

References 12 publications

Poorer survival of nulliparous women with endometrial carcinoma

Poorer survival of nulliparous women with endometrial carcinoma

Cervical cancer prevented by screening: Long‐term incidence trends by morphology in Norway

Treatment of pre-invasive conditions during opportunistic screening and its effectiveness on cervical cancer incidence in one Norwegian county

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