Advancing Age and Cervical Cancer Screening and Prognosis

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 49; no. 11; pp. 1499 - 1504
• Main Authors: Sawaya, George F., Sung, Hai-Yen, Kearney, Kathleen A., Miller, Marie, Kinney, Walter, Hiatt, Robert A., Mandelblatt, Jeanne
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01.11.2001; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Ageing; Biological and medical sciences; California; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Cervical cancer; cervical neoplasia; Elderly women; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Mass Screening - statistics & numerical data; Medical diagnosis; Medical sciences; Medical screening; Middle Aged; Miscellaneous; Neoplasm Invasiveness; Neoplasm Staging; Older people; older women; Patient Acceptance of Health Care - statistics & numerical data; Prevention and actions; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Screening; Survival Rate; Tumors; Uptake; USA; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; vaginal smears; Vaginal Smears - statistics & numerical data; Women; Human; Carcinoma; Review; Uterine cervix; Diagnosis; Malignant tumor; Medical screening; Elderly; Uterine cervix diseases; Age; Female genital diseases
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2001.4911243.x

OBJECTIVES: To determine associations between advancing age and screening behavior and prognosis in long‐term members of a prepaid health plan diagnosed with invasive cervical cancer (ICC). DESIGN: Case series. SETTING: Prepaid health plan. PARTICIPANTS: All women diagnosed with ICC at Kaiser Permanente Medical Care Program—Northern California health plan from 1988 to 1994. MEASUREMENTS: From medical records, we recorded participants' age, stage at diagnosis, tumor histology, and results of and reasons for all previous cervical smears. We limited our analysis to women who had been members of the health plan for at least 30 of the 36 months preceding diagnosis (n = 455). RESULTS: Women in older age groups were less likely than younger women to have been screened within the 3 years before diagnosis (P = .005 for trend). Nonadherence to follow‐up of abnormal cervical smears was uncommon (17/455, 3.7%) and not age related (P = .932 for trend). The proportions of ICC that were interval cancers, defined as ICC diagnosed within 3 years of a negative screening smear, were highest in women under age 30 (P = .004 for trend). In multivariate analyses controlling for stage at diagnosis, women age 60 and older were not more likely to die of ICC within 3 years of diagnosis than were women younger than age 60 (odds ratio 1.30, 95% confidence interval 0.75–2.28). CONCLUSION: The disproportionate burden of cervical cancer observed in older women appears to be largely attributable to lack of screening within the 3 years before diagnosis. J Am Geriatr Soc 49:1499–1504, 2001.