A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States

Authors

Christopher Mathews, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
Michael Robertson, University of New Mexico Comprehensive Cancer Center, The Center for HPV Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Charles L. Wiggins, University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Yolanda J. McDonald, Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
Daniel W. Goldberg, Department of Geography, Texas A&M University, College Station, TX, USA
Isabel C. Scarinci, Division of Preventive Medicine, University of Alabama at Birmingham, AL, USA
Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Cosette M Wheeler, Departments of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Rebecca Landy, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA. Electronic address: rebecca.landy@nih.gov
Peter D. Sasieni, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom

Document Type

Article

Publication Date

11-1-2020

Abstract

OBJECTIVE: Despite widespread cervical screening, an estimated 13,800 women will be diagnosed with cervical cancer in the United States in 2020. To inform improvements, the screening histories of women diagnosed with cervical cancer in New Mexico were assessed.

METHODS: Data were collected on all cervical screening, diagnostic tests and treatment procedures for all women diagnosed with cervical cancer aged 25-64 yrs. in New Mexico from 2006 to 2016. Women were categorized by their screening attendance in the 5-40 months (screening interval) and 1-4 months (peri-diagnostic interval) prior to cancer diagnosis.

RESULTS: Of the 504 women diagnosed between May 2009-December 2016, 64% were not screened or had only inadequate screening tests in the 5-40 months prior to diagnosis, and 90 of 182 screened women (49%) had only negative screens in this period. Only 32% (N = 162) of cervical cancers were screen-detected. Women with adenocarcinomas were more likely to have had a recent negative screen (41/57 = 722%) than women with squamous cancers (50/112 = 45%). Both older women (aged 45-64 years) and women with more advanced cancers were less likely to have been screened, and if screened, were more likely to have a false-negative outcome. Only 9% of cancers were diagnosed in women who did not attend biopsy or treatment after positive tests requiring clinical management. Screening currently prevents 35% of cancers, whereas full screening coverage could prevent 61% of cervical cancers.

CONCLUSION: Improved screening coverage has the largest potential for reducing cervical cancer incidence, though there is also a role for improved recall procedures and screening sensitivity.

Recommended Citation

Landy R, Mathews C, Robertson M, Wiggins CL, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Sasieni PD, Wheeler CM. A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States. Gynecol Oncol. 2020 Nov;159(2):344-353. doi: 10.1016/j.ygyno.2020.08.033. Epub 2020 Sep 22. Erratum in: Gynecol Oncol. 2021 Jun;161(3):913. Erratum in: Gynecol Oncol. 2021 Dec;163(3):614. PMID: 32977987; PMCID: PMC7594931.