Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data

Abstract

Objective: To study the effect of cervical screening on incidence of cervical cancer as a function of age with particular focus on women screened under the age of 25.

Design: Population based case-control study with prospectively recorded data on cervical screening.

Setting: Selected centres in the United Kingdom.

Participants: 4012 women aged 20-69 with invasive cancer diagnosed in participating centres and two controls per case individually matched on age and area of residence.

Main outcome measures: Odds ratios for strength of association between cervical cancer and screening at particular ages.

Results: There is no evidence that screening women aged 22-24 reduced the incidence of cervical cancer at ages 25-29 (odds ratio 1.11, 95% confidence interval 0.83 to 1.50). Similar results were seen for cancers restricted to squamous carcinoma or FIGO (International Federation of Gynaecology and Obstetrics) stage IB or worse, but the numbers are insufficient to provide narrow confidence intervals. Screening was associated with a 60% reduction of cancers in women aged 40, increasing to 80% at age 64. Screening was particularly effective in preventing advanced stage cancers.

Conclusions: Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer. These data should help policy makers balance the impact of screening on cancer rates against its harms, such as overtreatment of lesions with little invasive potential.

Fig 1 Cases included in this paper

Fig 2 Odds ratio for developing invasive cervical cancer stage IA or worse (in the next five year interval) in those screened in a given (three year) age band compared with those not screened in that age band (or in two previous years). Odds ratios plotted for overlapping age bands. Broken lines indicate risk of developing cervical cancer at ages 33-40 and 43-65. Odds ratios and confidence intervals are truncated at 1.2. Figure is based on 4012 cases (including 437 in women under age 30) and 7889 controls

Fig 3 Effect of stage and histology type on odds ratio of developing cervical cancer (in next five year interval) given screening in indicated age bands. Graph shows diagnosed cancer with five years of follow-up and compares those screened in the previous three years with those not screened in the previous five years. A: 2589 cases (303 in women under age 30) and 5122 controls; B: 2448 cases (172 in women under age 30) and 4821 controls; C: 1525 cases (107 in women under age 30) and 3025 controls; D: 897 cases (38 in women under age 30) and 1764 controls