FC 01-02SCREENING HISTORY IN CERVICAL CANCER PATIENTS ≥ 55 YEARS DIAGNOSED DURING 1990-2013 IN DENMARK

02. Epidemiology and natural history
A. Hammer 1, L. Hee 2, J. Blaakær 1, P. Gravitt 3.
1Department of Obstetrics and Gynecology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University (Denmark), 2Department of Obstetrics and Gynecology, Hilleroed Hospital (Denmark), 3Department of Global Health, George Washington University (United States)

Background / Objectives

The incidence of cervical cancer has declined significantly in developed countries following the implementation of cervical cancer screening.  However, previous studies have reported that ~50% of cervical cancer patients have not attended screening and that the fraction of unscreened women increases by age. This study aimed to describe the temporal pattern of screening in cervical cancer patients ≥55 years diagnosed during 1990 – 2013 at Aarhus University Hospital, Denmark

 

 

 

 

 


Methods

This hospital based cohort study included women ≥ 55 years diagnosed with cervical cancer at the Department of Pathology, Aarhus University Hospital, Denmark during 1990-2013 (n=515). Information on their previous history of cervical cancer screening was obtained from the Danish Pathology Databank.


Results

Overall, 47.0% (95% CI 42.6 – 51.4) had never been screened prior to cervical cancer diagnosis. The fraction of never screened cases declined over calendar time from 69.8% (95% CI 61.4 – 77.3) in 1990 – 1994 to 20.0% (95% CI 12.7 – 29.2) in 2010 – 2013, reflecting a period effect of screening. Conversely, the fraction of never screened cases increased by age from 22.5% (95% CI 14.6 – 32.0) in women aged 55 – 59 years to 63.2% (95% CI 49.3 – 75.6) in women ≥ 80 years. Noteworthy, the vast majority of never screened (90.9% ; 95% CI 86.6 – 94.2) lived in a period where screening was not available, whereas only 9.1% (95% CI 5.8 – 13.4) had not been screened although screening was available. Among women who had been screened 5 years or 5-10 years prior to cervical cancer diagnosis, 84.6% (95% CI 77.1 – 92.2) and 85.9% (95% CI 75.0 – 93.4) had a normal cytology result, respectively.


Conclusion

Cervical cancer in older women may partly be attributed to a lack of screening or due to a failure in screening. However, older women were in general less screened because they either lived in a period where screening was not available or they were too old to be screened when screening was implemented. Furthermore, since previous studies have shown that older women are at high risk of cervical cancer1,2, more information on how to best screen older women is needed.


References

1. The temporal and age-dependent patterns of hysterectomy-corrected cervical cancer incidence rates in Denmark: a population-based cohort study.

Hammer A, Kahlert J, Rositch A, Pedersen L, Gravitt P, Blaakaer J, Soegaard M. Acta Obstet Gynecol Scand. 2017 Feb;96(2):150-157.

2. Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009.

Rositch AF, Nowak RG, Gravitt PE. Cancer. 2014 Jul 1;120(13):2032-8.