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Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program

International journal of cancer, 2020-03, Vol.146 (5), p.1230 [Peer Reviewed Journal]

2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. ;ISSN: 0020-7136 ;ISSN: 1097-0215 ;EISSN: 1097-0215 ;DOI: 10.1002/ijc.32416 ;PMID: 31107987

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Title:
Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program
Author: Wang, Jiangrong ; Elfström, K Miriam ; Andrae, Bengt ; Nordqvist Kleppe, Sara ; Ploner, Alexander ; Lei, Jiayao ; Dillner, Joakim ; Sundström, Karin ; Sparén, Pär
Subjects: Adult ; Aged ; Benchmarking - statistics & numerical data ; Case-Control Studies ; cervical cancer ; cervical screening ; Cervix Uteri - pathology ; cytology ; Early Detection of Cancer - statistics & numerical data ; Female ; Humans ; Mass Screening - organization & administration ; Mass Screening - statistics & numerical data ; Medical Audit - statistics & numerical data ; Medicin och hälsovetenskap ; Middle Aged ; Papanicolaou Test - statistics & numerical data ; Patient Participation - statistics & numerical data ; Pregnancy ; prevention ; Program Evaluation ; Registries - statistics & numerical data ; Risk Assessment ; Sweden - epidemiology ; Uterine Cervical Neoplasms - diagnosis ; Uterine Cervical Neoplasms - epidemiology ; Uterine Cervical Neoplasms - pathology ; Young Adult
Is Part Of: International journal of cancer, 2020-03, Vol.146 (5), p.1230
Description: Our study used a refined case-control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular-participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register-based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002-2011, and 30 population-based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8-4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5-1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2-5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice.
Publisher: United States
Language: English
Identifier: ISSN: 0020-7136
ISSN: 1097-0215
EISSN: 1097-0215
DOI: 10.1002/ijc.32416
PMID: 31107987
Source: SWEPUB Freely available online

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Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program

2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. ;ISSN: 0020-7136 ;ISSN: 1097-0215 ;EISSN: 1097-0215 ;DOI: 10.1002/ijc.32416 ;PMID: 31107987

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