CERVICAL CANCER SCREENING EFFICACY IN OLDER WOMEN

通过巴氏涂片进行宫颈癌筛查，明显减轻了育龄妇女患宫颈癌的负担。 不幸的是，在超过生育年龄的妇女中，子宫颈筛查的有用性是不确定的。 我们建议使用病例对照研究设计来评估宫颈筛查在老年妇女中的有效性。 我们将比较在美国西北部的两个大型健康维护组织之一登记的两组老年妇女（55-79岁）先前使用巴氏涂片。该提案的总体目标是评估通过巴氏涂片检查对老年妇女进行子宫颈筛查可在多大程度上降低子宫颈癌的发病率。具体目标是：（1）确定筛查阴性的老年妇女中浸润性宫颈癌的发病率;（2）比较患有浸润性宫颈癌的老年妇女和没有宫颈筛查史的类似妇女。病例将包括1980-1997年期间在团体健康合作社或Kaiser Permanente Northwest登记时患浸润性宫颈癌的妇女。 资格将限于连续入学七年的妇女。对于每一个病例，将从以前没有做过子宫切除术的登记者中随机抽取三个对照组，并与健康计划中登记的年龄和持续时间相匹配。将审查研究受试者的医疗记录，以确定是否接受了巴氏涂片筛查和其他与发生宫颈癌风险相关的信息（即，吸烟）。 将比较病例和对照组在肿瘤侵入前可检测阶段的筛查史。在某种程度上，筛查导致宫颈癌的发病率在这一人群中降低，筛查史-在存在前驱病变的时间段内，但在癌症发展之前-在对照组中比病例中更常见。 拟议研究的结果应提供更坚实的基础，建议继续（或扩大）对老年妇女进行子宫颈检查，或减少检查水平，并将节省的费用分配给更有效的健康促进手段。

Screening for cervical cancer, by means of the Pap smear, has demonstrably reduced the burden of cervical cancer among women of reproductive ages. Unfortunately, in women beyond the reproductive years the usefulness of cervical screening is uncertain. We propose to evaluate the efficacy of cervical screening in older women using a case-control study design. We will compare the prior use of the Pap smear in two groups of older women (55-79 years of age) enrolled at one of two, large, health maintenance organizations in the northwestern United States. The overall goal of this proposal is to assess, in older women, the degree to which screening of the uterine cervix, by means of a Pap smear, can reduce the incidence of cancer of the cervix. The specific aims are: (1) to determine the incidence of invasive cervical cancer in older women following a negative screening exam; and (2) to compare older women who develop invasive cervical cancer and an otherwise similar group of women without this condition for a history of cervical screening. Cases will consist of those women who developed invasive cervical cancer during 1980-1997 while enrolled at either Group Health Cooperative or Kaiser Permanente Northwest. Eligibility will be restricted to women with seven years of continuous enrollment. For each case, three controls will be randomly sampled from enrollees who have not previously had a hysterectomy and matched to cases on age and duration of enrollment in the health plan. Medical records of the study subjects will be reviewed to ascertain receipt of Pap smear screening and other information relevant to the risk of developing cervical cancer (i.e., smoking). Cases and controls will be compared for a history of screening during the pre-invasive detectable phase of the tumor. To the extent that screening leads to a reduced incidence of cervical cancer in this population, a history of screening - during the time period in which the precursor lesion is present, but prior to the development of cancer - will be more common in controls than cases. The results of the proposed study should provide a more solid basis either for recommending continued (or expanded) cervical screening of older women, or instead for a reduced level of screening and an allocation of the cost savings to more productive means of health promotion.