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.
Keywords: HPV; cancer registry; cancer screening; case-control; cervical cancer; cervical screening; cytology; pap smear.
© 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
The Clinical Effectiveness and Cost-Effectiveness of Primary Human Papillomavirus Cervical Screening in England: Extended Follow-Up of the ARTISTIC Randomised Trial Cohort Through Three Screening RoundsH C Kitchener et al. Health Technol Assess 18 (23), 1-196. PMID 24762804. - Randomized Controlled TrialHPV testing as an initial screen was significantly more protective over three rounds (6 years) than the current practice of cytology and the use of primary HPV screening …
Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]J Melnikow et al. PMID 30256575. - ReviewEight large randomized trials, four of primary hrHPV testing and four of hrHPV cotesting, contributed to the evidence comparing use of hrHPV testing as part of cervical c …
[Health Technology Assessment Report: Computer-assisted Pap Test for Cervical Cancer Screening]P Della Palma et al. Epidemiol Prev 36 (5 Suppl 3), e1-43. PMID 23139174.the fully automated computer-assisted Pap test has an important financial and organizational impact on screening programmes. The assessment of this health technology reac …
HPV Testing Compared With Routine Cytology in Cervical Screening: Long-Term Follow-Up of ARTISTIC RCTC Gilham et al. Health Technol Assess 23 (28), 1-44. PMID 31219027.We found a similar level of protection 10 years after a negative HPV test and 3 years after negative cytology. These data support a considerably longer screening interval …
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