Cervical testing beyond the screening target age – A register-based cohort study from Finland

Keltto, Natalie; Leivonen, Aku; Pankakoski, Maiju; Sarkeala, Tytti; Heinävaara, Sirpa; Anttila, Ahti

doi:10.1016/j.ygyno.2021.05.019

Cited by 4 publications

(4 citation statements)

References 27 publications

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“… 23 The decreasing interest in screening with advancing age also explains why older women have higher incidences of CC, especially where screening programs have an opportunistic character, as is the case in Brazil. 24 25 These explanations were also advanced in Australia 26 and Finland 27 to explain the frequency of abnormal tests in older women with a history of inadequate screening.…”

Section: Discussionmentioning

confidence: 99%

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Zago,

Camilo-Júnior,

D'Ávilla

et al. 2023

Rev Bras Ginecol Obstet

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Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188–15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

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Section: Discussionmentioning

confidence: 99%

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Zago,

Camilo-Júnior,

D'Ávilla

et al. 2023

Rev Bras Ginecol Obstet

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“…The lack of participation in screening has been repeatedly linked to lower education, non-native mother tongue, and living alone ( 50–53 ). Conversely, women of higher socioeconomic status, such as those with high education and wealth, participate to screening excessively by using opportunistic testing frequently ( 20 ), and the same phenomenon is evident in the older population as well ( 54 ). Indeed, opportunistic testing may exclude those with lower socioeconomic position ( 55, 56 ), as the screening program is free of charge in Finland and opportunistic testing is often paid independently ( 54 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, women of higher socioeconomic status, such as those with high education and wealth, participate to screening excessively by using opportunistic testing frequently ( 20 ), and the same phenomenon is evident in the older population as well ( 54 ). Indeed, opportunistic testing may exclude those with lower socioeconomic position ( 55, 56 ), as the screening program is free of charge in Finland and opportunistic testing is often paid independently ( 54 ). These individuals have a higher cancer burden due to being more likely non-attenders and having possible risk factors ( 57, 58 ), highlighting the importance of encouraging attendance to organized screening.…”

Section: Discussionmentioning

confidence: 99%

Effect of Test History at Ages 50–64 on Later Cervical Cancer Risk: A Population-based Case–control Study

Kultalahti,

Heinävaara,

Sarkeala

et al. 2023

Cancer Research Communications

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As life expectancy increases, the effectiveness of cervical cancer screening programs needs to be reassessed for the older population. We addressed the effect of test history in and outside organized screening at age 50–64 years on later cervical cancer risk. A case-control study was conducted by deriving 229 cases of 65–79-year-old women with invasive cervical cancer in 2010–2019 from the Finnish Cancer Registry. Ten controls were matched for each case by birth year and hospital district. The effect of test uptake and abnormal results in 50–64-year-olds on cancer risk was investigated using conditional logistic regression and adjusted for self-selection. Test uptake within the 50–64-year age-group showed 75% lower odds of cervical cancer (adjusted odds ratio [aOR] = 0.25; 95% confidence interval [95% CI], 0.18–0.35). Untested women had 4.9 times higher odds than those tested with normal results (aOR = 4.86; 95% CI, 3.42–6.92). Having at least one abnormal test result increased the odds by 2.5 when compared to only normal results but showed lower odds when compared to untested women. The importance of testing is exhibited by the result showing a reduction of odds of cancer to one-fourth for those tested compared to untested. Similarly, receiving abnormal results was protective of cancer compared to having no tests highlighting the importance of proper follow-up. Therefore, screening history should be considered when further developing cervical cancer screening programs with special interest in non-attenders and those receiving abnormal results at older ages.

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“…In the age-specific analysis, we were able to control for education only in the oldest age bands. Because women tested above the target age were more likely to have high social status and no previous abnormal findings [ 31 ], it is likely that we were not able to fully control for selection bias at the oldest ages.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Cervical Testing in and outside a Screening Program—A Case-Control Study

Pankakoski

Sarkeala

Anttila

et al. 2022

Cancers

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In many countries with organized cervical cancer screening, opportunistic Pap and human papillomavirus (HPV) tests are common. However, little is known about their effectiveness. We examined the effect of testing in and outside the Finnish screening program on the risk of cervical cancer. We conducted a case-control study that involved 1677 cases with invasive cervical cancer that were diagnosed between 2010 and 2019. Five- and three-year test intervals were analyzed across all ages, by age group and by cancer morphology subtype. Conditional logistic regression was used, adjusting for socioeconomic variables. Women undergoing any kind of cervical test had a significantly lowered risk of cervical cancer (adjusted OR = 0.43, 95% CI = 0.38–0.48, tests in five-year intervals). The results were similar, regardless of whether the test had been taken in the screening program or outside of it, or whether the interval was five years or three years. Testing of women at ages 35–64 showed the strongest effects, but moderate preventive effects were seen until age 79. No significant effect was seen below age 30. Tests in and outside the program were effective at the screening target age. However, participation in the program should be encouraged for optimal cost-effectiveness. Preventive effects were also seen above the program target ages.

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Cervical testing beyond the screening target age – A register-based cohort study from Finland

Cited by 4 publications

References 27 publications

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Effect of Test History at Ages 50–64 on Later Cervical Cancer Risk: A Population-based Case–control Study

Effectiveness of Cervical Testing in and outside a Screening Program—A Case-Control Study

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