Decreased incidence of cervical cancer in medicare-eligible California women.
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.
Cornelison
Terri L
TL
Kelly Gynecologic Oncology Service, Department of Gynecology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21210, USA.
Montz
Fredrick J
FJ
Bristow
Robert E
RE
Chou
Betty
B
Bovicelli
Alessandro
A
Zeger
Scott L
SL
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*