Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Cancer Med. 2019 Jan;8(1):418-427. doi: 10.1002/cam4.1926. Epub 2019 Jan 1.
The incidence and mortality of cervical cancer are high in Danish women aged 60 years and older who are about to exit the cervical cancer screening program. The present study aimed to describe the screening history in women ≥60 years old, diagnosed with cervical cancer in Denmark, 2009-2013. We retrieved information on cases of cervical cancer and previous cervical cancer screening from national registries. During the study period, a total of 1907 women were diagnosed with cervical cancer, 574 (30.1%) of which were ≥60 years old. The majority of women were diagnosed with squamous cell carcinoma (73.7%) and advanced-stage disease (ASD, ie, ≥FIGO IIB; 63.1%). The proportion of ASD increased with age, from 51.9% in women aged 60-64% to 76.7% in women aged 75-79. Among screened women (n = 377), 22.8% had a cervical cytology within 5 years of diagnosis, 73.3% of which were normal, and 45.1% were diagnosed with ASD. Women who had been sufficiently screened prior to screening exit (≥2 normal cytology test in the age interval 50-59) accounted for 18.1%. Of note, 53.8% of the sufficiently screened women were diagnosed with ASD. Sufficiently screened women were less likely to be diagnosed with ASD compared to never-screened women (53.8% vs 67.5%, P < 0.020), but no difference was observed between sufficiently and insufficiently screened women (53.8% vs 63.4%, P = 0.091). Our findings suggest that cancer in older women may occur due to insufficient screening prior to screening exit, a low sensitivity of screening, and premature screening exit.
丹麦即将退出宫颈癌筛查计划的 60 岁及以上老年女性中，宫颈癌的发病率和死亡率较高。本研究旨在描述 2009-2013 年丹麦年龄在 60 岁及以上、被诊断患有宫颈癌的女性的筛查史。我们从国家登记处检索了宫颈癌病例和之前宫颈癌筛查的信息。在研究期间，共有 1907 名女性被诊断患有宫颈癌，其中 574 名（30.1%）年龄在 60 岁及以上。大多数女性被诊断为鳞状细胞癌（73.7%）和晚期疾病（ASD，即≥FIGO IIB；63.1%）。ASD 的比例随年龄增加而增加，从 60-64 岁女性的 51.9%增加到 75-79 岁女性的 76.7%。在接受筛查的女性（n=377）中，22.8%在诊断前 5 年内进行了宫颈细胞学检查，其中 73.3%结果正常，45.1%被诊断为 ASD。在退出筛查前（50-59 岁间隔期进行 2 次正常细胞学检查）进行了充分筛查的女性占 18.1%。值得注意的是，53.8%的充分筛查女性被诊断为 ASD。与从未接受过筛查的女性相比，充分筛查的女性被诊断为 ASD 的可能性较低（53.8%比 67.5%，P<0.020），但充分和未充分筛查的女性之间无差异（53.8%比 63.4%，P=0.091）。我们的研究结果表明，由于退出筛查前筛查不足、筛查敏感性低以及过早退出筛查，老年女性的癌症可能发生。
