title: Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011.
abstract: Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of population-based linked health records for 1,334,795 female Queensland residents aged 20-69 years who had one or more Pap smears during 2000-2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and high-grade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010-2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6-18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3-7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3-1.4), cHGA (OR 2.2, CI 2.1-2.3) and hHGA (OR 2.0, CI 1.9-2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Whop
authors.affiliation: Cancer Council Queensland, Brisbane, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Baade
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Cunningham
authors.affiliation: Victorian Cytology Service Inc, Melbourne, Victoria, Australia.|School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Julia M L
authors.initials: JM
authors.lastname: Brotherton
authors.affiliation: National Centre of Epidemiology and Public Health, Australian National University, Canberra, Australia.
authors.forename: Kamalini
authors.initials: K
authors.lastname: Lokuge
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.|QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia.|School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia.|School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: Abbey
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.affiliation: School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Dorota M
authors.initials: DM
authors.lastname: Gertig
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Moore
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Condon
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002584:Cervix Uteri / Q000473:pathology*; D003584:Cytological Techniques; D055088:Early Detection of Cancer; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006801:Humans; D016247:Information Storage and Retrieval; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D065006:Papanicolaou Test / Q000379:methods; D044382:Population Groups; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000453:epidemiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014626:Vaginal Smears