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. 2012 Mar 1:344:e900.
doi: 10.1136/bmj.e900.

Screening and cervical cancer cure: population based cohort study

Bengt Andrae  1 , Therese M-L Andersson, Paul C Lambert, Levent Kemetli, Lena Silfverdal, Björn Strander, Walter Ryd, Joakim Dillner, Sven Törnberg, Pär Sparén
Affiliations

Screening and cervical cancer cure: population based cohort study

Bengt Andrae et al. BMJ. .

Abstract

Objective: To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

Design: Nationwide population based cohort study.

Setting: Sweden.

Participants: All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years.

Main outcome measures: Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.

Results: In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).

Conclusions: Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Definition of mode of detection and screening history based on time since latest smear test.* Result of smear tests taken without clinical suspicion do not lead to diagnosis of invasive cancer in less than one month. †Smear tests taken less than six months before diagnosis cannot have prevented invasive cancer but are considered, after referral and biopsy, to lead to diagnosis of a prevalent cancer
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Fig 2 Relative survival ratios of cervical cancer (all histological types) for women of all ages, by screening history and mode of detection
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Fig 3 Relative survival ratios of cervical cancer for women of all ages, by histological type
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Fig 4 Relative survival ratios of cervical cancer (all histological types) for women of all ages, by FIGO stage
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References

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