title: Decreased incidence of cervical cancer in medicare-eligible California women.
abstract: OBJECTIVE
  To determine if the incidence of invasive cervical cancer relative to carcinoma in situ decreased in Medicare-eligible women.
  
  
  METHODS
  A retrospective cohort was amassed from the California Cancer Registry database. The hypothesis was prospectively specified. Mean ratio of invasive (International Federation of Gynecology and Obstetrics Stages I-IV) to in situ cervical carcinoma in 1988-1990 versus 1991-1995 was stratified by age (24 or younger, 25-44, 45-64, 65 or older) and race (all races, whites, blacks, Hispanics, Asian/Pacific Islanders).
  
  
  RESULTS
  The mean ratio of invasive to in situ cervical cancer incidence for women at least 65 years old was lower in 1991-1995 compared with 1988-1990 (P <.001, 95% confidence interval 0.893, 0.954); and had decreased more than observed for women aged 45-64 and 25-44, for all races combined, and for white women. The decreased ratio of invasive to in situ cancer for blacks, Hispanics, and Asian/Pacific Islanders at least 65 years old was no different than the decreased ratio in younger women.
  
  
  CONCLUSIONS
  In California, in the 5 years after the 1990 change in Medicare funding statutes for cervical cytology screening, the ratio of invasive cervical cancer to in situ disease decreased more in Medicare-eligible patients than in younger women.
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21210, USA.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Cornelison
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Montz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Betty
authors.initials: B
authors.lastname: Chou
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bovicelli
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeger
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002140:California / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics*; D006278:Medicare / Q000191:economics* / Q000592:standards; D008875:Middle Aged; D011050:Policy Making; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*