Benefit of cervical screening at different ages: evidence from the UK audit of screening histories.
While most experts agree that cervical screening is effective, there remains controversy over the most appropriate screening interval. Annual screening is common in North America. In England, some argue for 3-yearly screening while others believe 5-yearly screening is adequate, and the frequency varies from one part of the country to another. Screening histories of 1305 women aged 20-69 years, diagnosed with frankly invasive cervical cancer and 2532 age-matched controls were obtained from UK screening programme databases. Data were analysed in terms of time since last negative, and time since last screening smear. Five-yearly screening offers considerable protection (83%) against cancer at ages 55-69 years and even annual screening offers only modest additional protection (87%). Three-yearly screening offers additional protection (84%) over 5-yearly screening (73%) for cancers at ages 40-54 years, but is almost as good as annual screening (88%). In women aged 20-39 years, even annual screening is not as effective (76%) as 3-yearly screening in older women, and 3 years after screening cancer rates return to those in unscreened women. This calls into question the policy of having a uniform screening interval from age 20 to 64 years and stresses the value of screening in middle-aged women. British Journal of Cancer (2003) 89, 88-93. doi:10.1038/sj.bjc.6600974 www.bjcancer.com
Sasieni
P
P
Cancer Research UK, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK. peter.sasieni@cancer.org.uk
Adams
J
J
Cuzick
J
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006291:Health Policy; D006801:Humans; D008403:Mass Screening; D008485:Medical Audit; D008487:Medical History Taking; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017410:Practice Guidelines as Topic; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears