title: Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions.
abstract: OBJECTIVE
  Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000-2011.
  
  
  METHODS
  323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%).
  
  
  RESULTS
  History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2-5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2-4.5). FIGO II-IV cases were more common among older women (older than 60 years).
  
  
  CONCLUSIONS
  Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.
authors.affiliation: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), Avenida Gran Vía 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Ibáñez
authors.affiliation: Pathology Department, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, 08906 Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Alejo
authors.affiliation: Pathology Department, Corporació Sanitaria Parc Tauli, Sabadell, 08208 Barcelona, Spain.
authors.forename: Neus
authors.initials: N
authors.lastname: Combalia
authors.affiliation: Pathology Department, Hospital Mutua de Terrassa, Terrassa, 08221 Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Tarroch
authors.affiliation: Pathology Department, Consorci Hospitalari de Vic, Vic, 08500 Barcelona, Spain.
authors.forename: Josefina
authors.initials: J
authors.lastname: Autonell
authors.affiliation: Pathology Department, Hospital d'Althaia, Manresa, 08243 Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Codina
authors.affiliation: Pathology Department, Consorci Sanitari de Terrassa, Terrassa, 08227 Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Culubret
authors.affiliation: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), Avenida Gran Vía 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Bosch
authors.affiliation: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), Avenida Gran Vía 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain ; CIBER Epidemiology and Public Health, 08036 Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011786:Quality Control; D013030:Spain / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology