Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

Hammer, Anne; Soegaard, Vibeke; Maimburg, Rikke Damkjær; Blaakær, Jan

doi:10.1002/cam4.1926

Cited by 30 publications

(25 citation statements)

References 46 publications

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“…It should, however, be taken into account that after 50 years of screening, the current age-specific incidence of cervical cancer is no longer a pure reflection of the underlying risk of the disease, but it reflects also the screening history of the respective birth cohort. A study of cervical cancer patients aged 60 and above in Denmark in 2009-2013 found the average age of non-screened patients to be 76 years, in line with the current second top on the incidence curve [2].…”

Section: Introductionmentioning

confidence: 71%

HPV-prevalence in elderly women in Denmark

Andersen

Christensen

et al. 2019

Gynecologic Oncology

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Aim. In countries like Denmark, cervical cancer incidence is at present relatively high in elderly women, while routine screening stops at age 65 years. On this background, all women aged 69 and above were invited to human papillomavirus (HPV)-screening in Denmark in 2017.Methods. Women were identified from the Central Population Register and personally invited by digital or ordinary mail to have a screening sample taken by their general practitioner. In four regions, samples were tested for high risk (HPV) with the cobas 4800® HPV-assay, and in the last region with the BD Onclarity® HPV-assay. Participation rate, prevalence of high risk HPV, and proportion of positive samples with HPV16, HPV18, and other high risk HPV-types were tabulated by 5-year age-groups.Results. 455,612 women were invited, and 30.2% (95 confidence interval (CI) 30.0-30.3) participated. Average age of participants was 74.6 years. Overall, 4.3% (95% CI 4.1-4.4) of participants were HPV-positive, of whom 24% had HPV 16/18. HPV-prevalence decreased slightly from 4.5% in women aged 69-73 years to 3.1% in women aged 84-88 years, but was 5.2% in the very small group of participants aged 89+ years.Conclusion. Invitation to HPV-screening was well received by elderly women. The HPV-prevalence decreased slightly with increasing age. No rebound of HPV-prevalence after menopause was found when our data were combined with previously published Danish data from younger women. The presently relatively high cervical cancer incidence in elderly women was not reflected in the HPV-prevalence.

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Section: Introductionmentioning

confidence: 71%

HPV-prevalence in elderly women in Denmark

Andersen

Christensen

et al. 2019

Gynecologic Oncology

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“…Besides, the inadequate early cervical screening in patients aged ≥65 possibly delayed the diagnosis and deteriorate the prognosis. 14,15 Regular cervical screening in patients above 65 years old helps reduce the incidence of cervical cancer by 75% and the mortality of the disease. 16 Therefore, deficiency of typical clinical features and cervical screening might contribute to late diagnosis.…”

Section: Discussionmentioning

confidence: 99%

<p>Characteristics and Treatments of Patients Aged 65 Years or Over with Cervical Cancer</p>

Xie¹,

Pan²,

Zou³

et al. 2020

CIA

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Purpose: Although the mortality of elderly women with cervical cancer is high, their characteristics and prognosis have not attracted sufficient attention. This study aims to clarify the prognostic factors of cervical cancer patients aged ≥65. Patient and Methods: The incidences and characteristics of patients diagnosed with cervical cancer (aged ≥65 and <65) during 2004-2015 were obtained through the Surveillance, Epidemiology, and End Results Program (SEER) database. The differences of distributions of characteristics between two age groups were compared by chi-squared (χ 2 ) test. Kaplan-Meier survival method, Log-rank test, Cox-regression and visual nomogram were utilized for survival analysis. Results: The annual incidences of two age groups with cervical cancer were (5.5-7.5)/100,000 and (3.4-3.9)/100,000, respectively, during 2004-2015. The 1-year and 5-year cancer-specific survival rates of old patients were both lower than those of young patients (P <0.001). The proportions of unmarried state and advanced International Federation of Gynecology and Obstetrics (FIGO) stage in old patients were higher than those in relatively young patients, and fewer elderly patients received surgery. Univariate and multivariate survival analysis showed nonsquamous cell carcinoma, poor differentiation and late FIGO stage were independent poor prognostic factors for patients aged ≥65. Treatments improved the outcomes of elderly patients, and the effect of surgery was better than non-surgical treatment on elderly patients with FIGO I. Besides, geriatric score and survival probability could be accomplished by our nomogram with a c-index of 0.7945. Conclusion: Delayed diagnosis and insufficient treatment were two distinct features of elderly patients and correlated with their poor clinical outcomes. More attention and active treatments should be adopted in elderly women based on their general condition.

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“…The high mortality in older women may be a result of a high proportion of advanced stage disease, high comorbidity and a high level of frailty, which likely affects the choice of treatment. Thus, older women are less likely to undergo radical surgery and receive external beam and intra‐cavitary radiation, which may affect their survival rate.…”

Section: Discussionmentioning

confidence: 99%

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

Hammer

Kahlert

Gravitt

et al. 2019

Acta Obstet Gynecol Scand

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Introduction We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age. Material and methods Using data from nationwide registries, we calculated uncorrected and hysterectomy‐corrected cervical cancer mortality rates among women age ≥20 years in Denmark during 2002‐2015. We calculated hysterectomy‐corrected rates by subtracting post‐hysterectomy person‐years from the denominator, unless hysterectomy was performed due to cervical cancer. Results The age‐standardized hysterectomy‐corrected cervical cancer mortality rate of 5.8/100 000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy‐corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100 000 person‐years in women aged ≥85. The hysterectomy‐corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100 000 person‐years in 2002 to 4.5/100 000 person‐years in 2015 (annual percent change −0.22). This was mainly due to a significant decline in women aged 60 years and older, from 20.4/100 000 person‐years in 2003 to 9.3/100 000 person‐years in 2015 (annual percent change −0.75). Conclusions The mortality of cervical cancer increased significantly by age, particularly among women aged 65 years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women.

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Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older—A national cohort study

Cited by 30 publications

References 46 publications

HPV-prevalence in elderly women in Denmark

HPV-prevalence in elderly women in Denmark

<p>Characteristics and Treatments of Patients Aged 65 Years or Over with Cervical Cancer</p>

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

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