Department of Mathematical Sciences, University of Puerto Rico at Mayagüez, Mayagüez, Puerto Rico.
Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
J Low Genit Tract Dis. 2023 Jan 1;27(1):19-23. doi: 10.1097/LGT.0000000000000709. Epub 2022 Nov 9.
Cervical cancer incidence is rising in Puerto Rico (PR). Screening for cervical cancer could prevent the occurrence of the disease or lead to its early detection, translating to survival benefits. In this study, we evaluated the association of cervical cancer screening status with tumor diagnosis and survival among Hispanic women living in PR.
We analyzed data for 506 incident cases of primary cervical cancer diagnosed from the period 2011-2014, identified through the PR Central Cancer Registry. We ascertained screening status 3 years before cervical cancer diagnosis using data from the period 2008-2014 from the PR Central Cancer Registry-Health Insurance Linkage Database. Patients were followed until 2019. Our outcomes of interest were stage at diagnosis and survival.
Most women (78.86%) were covered by public insurance (Medicare and/or Medicaid), and 69.57% underwent screening 3 years before their diagnosis. The proportion of cases diagnosed with localized stage was significantly greater among the screened group compared with those unscreened (43.5% vs 33.1%, p < .0001). Multivariate analysis showed that women insured through Medicaid were less likely to have been screened when compared with women with private insurance (odds ratio = 0.29; 95% CI = 0.16-0.52). Five-year survival was significantly greater among screened (72%) than unscreened (54%) women (p log-rank < 0.05). The multivariate Cox proportional hazards model showed that women who received screening had a 39% (hazard ratio [HR] = 0.61; 95% CI = 0.43-0.87) lower risk of death compared with unscreened women.
Our findings exemplify survival benefits among women who underwent cervical cancer screening in PR. Interventions to improve screening uptake and adherence are a public health priority.
波多黎各（PR）的宫颈癌发病率正在上升。宫颈癌筛查可以预防疾病的发生，或导致早期发现，从而带来生存获益。在这项研究中，我们评估了 PR 居住的西班牙裔女性的宫颈癌筛查状况与肿瘤诊断和生存之间的关联。
我们分析了 2011-2014 年期间通过 PR 中央癌症登记处确定的 506 例原发性宫颈癌的发病病例数据。我们使用 2008-2014 年 PR 中央癌症登记处-健康保险链接数据库的数据，在宫颈癌诊断前 3 年确定筛查状况。患者随访至 2019 年。我们感兴趣的结局是诊断时的分期和生存。
大多数女性（78.86%）有公共保险（医疗保险和/或医疗补助）覆盖，69.57%在诊断前 3 年接受了筛查。与未筛查组相比，筛查组中局部阶段的病例比例明显更高（43.5%比 33.1%，p<0.0001）。多变量分析显示，与私人保险女性相比，通过 Medicaid 保险的女性接受筛查的可能性较小（比值比=0.29；95%置信区间=0.16-0.52）。筛查组（72%）的 5 年生存率明显高于未筛查组（54%）（p log-rank<0.05）。多变量 Cox 比例风险模型显示，接受筛查的女性死亡风险比未筛查的女性低 39%（风险比[HR]=0.61；95%置信区间=0.43-0.87）。
我们的研究结果表明，在 PR 进行宫颈癌筛查的女性有生存获益。提高筛查参与度和依从性的干预措施是公共卫生的重点。
