A study of Pap test history and histologically determined cervical cancer in NSW women, 1997-2003

Morrell, Stephen, Taylor, Richard and Wain, Gerard (2005) A study of Pap test history and histologically determined cervical cancer in NSW women, 1997-2003. Journal of Medical Screening, 12 4: 190-196. doi:10.1258/096914105775220769


Author Morrell, Stephen
Taylor, Richard
Wain, Gerard
Title A study of Pap test history and histologically determined cervical cancer in NSW women, 1997-2003
Journal name Journal of Medical Screening   Check publisher's open access policy
ISSN 0969-1413
1475-5793
Publication date 2005-12-01
Sub-type Article (original research)
DOI 10.1258/096914105775220769
Volume 12
Issue 4
Start page 190
End page 196
Total pages 7
Place of publication London, United Kingdom
Publisher Royal Society of Medicine Press
Language eng
Subject 11 Medical and Health Sciences
1117 Public Health and Health Services
Formatted abstract
Objectives
To determine the risk of a histological diagnosis of cervical cancer following a given Pop test result and for a given history of Pap test results in a screened population across the full spectrum of possible cytological results.

Methods
All the Pap screening results held on the New South Wales Pap Test Register for 1997-2003 (five million tests for 1.87 million women) were analysed using Cox proportional hazards regression to estimate the odds of having a histologically determined cervical cancer for a given Pap test result and test result history. The hazard ratios of having cervical cancer in relation to Pap test result histories were estimated: (i) in regard only to the last Pap test result adjusting for age, frequency of Pap testing and proportion of high grade (>= cervical intraepithelial neoplasia 2 [CIN2]) abnormalities found in a woman's total recorded test result history; and (ii) with regard to the lost Pap test result against the highest grade of cytological abnormality found prior to the last Pap test result. The hazard ratios are for a cancer diagnosis occurring before the next Pap test and were adjusted for age, quintile of socioeconomic status of residence, frequency of past Pap testing and proportion of high-grade abnormalities detected in each woman's prior Pap test history. The adjusted hazard ratios were then applied to the tabulated proportions of referent women with negative cytology in each broad age group, and for all women, to estimate the '1 in n' odds of being diagnosed histologically with cervical cancer for a given lost Pap test result, and by a given last Pap test result for various prior Pap test result histories.

Results

After adjusting for age, socioeconomic status, frequency of previous Pap testing and proportion of past high-grade screen-detected abnormalities, the adjusted hazard ratio of having a subsequent cervical cancer diagnosis for women with a negative Pap test result was 1 in 55,46, compared with 1 in 833 for a low-grade epithelial abnormality (atypia, CIN1), I in 56 for a high-grade epithelial abnormality and 1 in seven for a cytological prediction of cervical cancer. These odds estimates were significantly modified by age and by the highest Pap test result prior to the most recent Pap test result: the higher the age and, less consistently, the higher the previous highest Pap test result for a given lost Pap test result, the shorter the odds of having a subsequent histological diagnosis of cervical cancer.

Conclusions
The results presented here will enable clinicians to inform their patients of their chances of being diagnosed with cervical cancer for a given Pop test result, and for some combinations of the last Pap test result and highest recorded prior Pap test result.
Keyword Public, Environmental & Occupational Health
Smear
Risk
Q-Index Code C1
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Public Health Publications
 
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Created: Tue, 14 Aug 2007, 01:51:09 EST