Abstract
Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case–control study was conducted with records from population‐based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006–2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case‐diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25–64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3‐year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12–0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38–0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5–5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.
Highlights
Cervical cancer is largely preventable, yet an estimated 13,170 women in the United States (US) will be diagnosed with invasive cervical cancer in 2019, an age-standardized rate of 7.6 per 100,000 women in 2011–2016.1 Cervical screening and human papillomavirus (HPV) vaccination are two methods of preventing cervical cancer
Our study addressed three key relevant questions related to the performance of cervical screening
Attending screening within a 3-year period reduced the odds of nonlocalized cancer by 83%, and Stage I cancer by 48% compared to women not screened in 5 years
Summary
Cervical cancer is largely preventable, yet an estimated 13,170 women in the United States (US) will be diagnosed with invasive cervical cancer in 2019, an age-standardized rate of 7.6 per 100,000 women in 2011–2016.1 Cervical screening and human papillomavirus (HPV) vaccination are two methods of preventing cervical cancer. Impact of screening on cervical cancer incidence. Screening is an effective means of preventing cervical cancer in women. While a negative screening result affords protection against cervical cancer, little is known about how long this protection lasts or when a woman should be screened again. The authors estimate the impact of cervical screening at a state-wide level, linking a U.S population-based screening registry with a SEER cancer registry. The results show that screening once every three years prevents 83 percent of stage 2+ cervical cancers, with no additional benefit from more frequent screening. The findings may help improve adherence to U.S screening guidelines
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