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Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program
Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.
Karolinska Inst, Dept Lab Med, Stockholm, Sweden;Reg Canc Ctr Stockholm Gotland, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.
Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
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2020 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 146, no 5, p. 1230-1240Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
WILEY , 2020. Vol. 146, no 5, p. 1230-1240
Keywords [en]
cervical screening, cytology, cervical cancer, prevention
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-403249DOI: 10.1002/ijc.32416ISI: 000506262300007PubMedID: 31107987OAI: oai:DiVA.org:uu-403249DiVA, id: diva2:1388992
Funder
Swedish Cancer Society, CAN 2016/840Swedish Foundation for Strategic Research , KF10-0046NordForsk, 62721Swedish Research Council, 2017-02346Available from: 2020-01-28 Created: 2020-01-28 Last updated: 2020-01-28Bibliographically approved

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