title: Advancing age and cervical cancer screening and prognosis.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Case series.
  
  
  METHODS
  Prepaid health plan.
  
  
  METHODS
  All women diagnosed with ICC at Kaiser Permanente Medical Care Program-Northern California health plan from 1988 to 1994.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 94143, USA.
authors.forename: G F
authors.initials: GF
authors.lastname: Sawaya
authors.forename: H Y
authors.initials: HY
authors.lastname: Sung
authors.forename: K A
authors.initials: KA
authors.lastname: Kearney
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: W
authors.initials: W
authors.lastname: Kinney
authors.forename: R A
authors.initials: RA
authors.lastname: Hiatt
authors.forename: J
authors.initials: J
authors.lastname: Mandelblatt
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data*