INCIDENCE OF INVASIVE CERVICAL-CANCER PRECEDED BY NEGATIVE SCREENING IN HIGH-RISK ALASKA NATIVE WOMEN

被引:12
作者
DAVIDSON, M
BULKOW, LR
LANIER, AP
SMITH, RA
HAWKINS, I
JENSEN, H
KIVIAT, N
机构
[1] CTR DIS CONTROL & PREVENT, NATL CTR INFECT DIS, ARCTIC INVEST PROGRAM, ANCHORAGE, AK 99501 USA
[2] ALASKA AREA NATIVE HLTH SERV, COMMUNITY HLTH SERV, ANCHORAGE, AK 99501 USA
[3] CTR DIS CONTROL & PREVENT, NATL CTR CHRON DIS PREVENT & HLTH PROMOT, DIV CANC PREVENT, ATLANTA, GA 30333 USA
[4] ALASKA NATIVE MED CTR, DEPT PATHOL, ANCHORAGE, AK 99501 USA
[5] RIGSHOSP, DK-2100 COPENHAGEN, DENMARK
[6] UNIV WASHINGTON, HARBORVIEW MED CTR, DEPT PATHOL, SEATTLE, WA 98104 USA
关键词
D O I
10.1093/ije/23.2.238
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background. Alaska Native women experience higher invasive cervical cancer incidence and mortality rates than US whites despite a long-standing cancer screening programme including recommendations for annual Pap smears. Methods. To determine the frequency and results of cytological screening preceding their diagnoses, a histological and medical record review was completed for 44 of 46 Alaska Native cases of invasive cervical cancer from a defined population. An interval cancer (no prior dysplasia and a negative screening report within 3 years of diagnosis) was determined for 23 women. Mean number of negative reports during the 3- and 5-year intervals before diagnosis was 1.7 and 2.6 respectively. The age-adjusted incidence rate for all cervical cancer was 24.0/100 000 women/year and for interval cancer with single and multiple negative reports during the 3-year interval before diagnosis it was 11.6, and 9.6 respectively. Sensitivity of a Pap smear to demonstrate dysplasia during the year before diagnosis was 51%. Conclusions. Annual cytological screening of all Alaska Native women with current methods would provide earlier diagnoses for only an additional 15% of cervical cancer cases. Plausible but unproven explanations include rapid progression through precursor stages of neoplasia or random screening errors. Improved or ancillary screening methods appear necessary.
引用
收藏
页码:238 / 245
页数:8
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