title: Cervical screening and cervical cancer death among older women: a population-based, case-control study.
abstract: Recent research suggests that cervical screening of older women is associated with a considerable decrease in cervical cancer incidence. We sought to quantify the efficacy of cervical cytology screening to reduce death from this disease. Among enrollees of 2 US health plans, we compared Papanicolaou smear screening histories of women aged 55-79 years who died of cervical cancer during 1980-2010 (cases) to those of women at risk of cervical cancer (controls). Controls were matched 2:1 to cases on health plan, age, and enrollment duration. Cytology screening during the detectable preclinical phase, estimated as the 5-7 years before diagnosis during which cervical neoplasia is asymptomatic but cytologically detectable, was ascertained from medical records. A total of 39 cases and 80 controls were eligible. The odds ratio of cervical cancer death associated with screening during the presumed detectable preclinical phase was 0.26 (95% confidence interval: 0.10, 0.63) after adjustment for matching characteristics, smoking, marital status, and race/ethnicity using logistic regression. We estimate that cervical cytology screening of all women aged 55-79 years in the United States could avert 630 deaths annually. These results provide a minimum estimate of the efficacy of human papillomavirus DNA screening-a more sensitive test-to reduce cervical cancer death among older women.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Rustagi
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Polly
authors.initials: P
authors.lastname: Newcomb
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality*
chemical_list: D004279:DNA, Viral
keywords: Papanicolaou smear; case-control studies; screening; uterine cervical neoplasms; women's health