title: Elderly women above screening age diagnosed with cervical cancer have a worse prognosis.
abstract: OBJECTIVE
  To analyze the cervical screening history in women with cervical cancer and their outcome.
  
  
  METHODS
  All women diagnosed with cervical cancer between January 2009 and December 2010 in the South Sweden region were included in the audit.
  
  
  METHODS
  Cervical cancer was registered in 165 women in 2009 and 2010. Their screening history was analyzed, and was classified as normal or imperfect. The method of discovering the cancer was either by symptoms or by screening. The main outcome measured was overall survival in cervical cancer related to cervical screening history.
  
  
  RESULTS
  Women above 65 years of age were more frequently diagnosed with advanced-stage disease (The International Federation of Gynecology and Obstetrics II-IV) (n=36 out of 43; 84%) compared to women below 65 years of age (n=35 out of 122; 29%) (p<0.001). All patients diagnosed by the cervical screening program were still alive (30/30) at the median follow-up time (36 months), showing better overall survival compared to women below screening age in whom cancer was discovered due to symptoms (68/98; p<0.001). Cox proportional hazards model showed that women beyond screening age (>65 years old) with normal screening history had a worse prognosis, with a hazard ratio of 4.8 (95% confidence interval=1.9-12.1, p=0.001), and women (>65 years old) who had not followed the screening program had a hazard ratio of 5.9 (95% confidence interval I 2.4-14.6, p<0.001), compared to women under 65 years old who had followed the screening program.
  
  
  CONCLUSIONS
  Cervical cancer in women above the age of 65 years is discovered at advanced stages of the disease and their prognosis is poor.
authors.affiliation: Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden Lotten.Darlin@med.lu.se.
authors.forename: Lotten
authors.initials: L
authors.lastname: Darlin
authors.affiliation: Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Borgfeldt
authors.affiliation: Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Emelie
authors.initials: E
authors.lastname: Widén
authors.affiliation: Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Päivi
authors.initials: P
authors.lastname: Kannisto
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*
keywords: Cervical screening program; HPV test; Swedish population; cervical cancer; overall survival