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Screening delay tied to advanced c.c, May 9 5/9/2008 1:25:40 PM

NEW YORK (Reuters Health) - Not having had a Pap smear taken within the recommended screening interval was the most important risk factor for advanced cervical cancer observed during an audit of Sweden's cervical cancer screening program.

Sweden's guidelines advise Pap smear screening every 3 years between the ages of 23 and 60, and every 5 years for women between the ages of 51 and 60. Dr. Bengt Andrae, at Gavle Hospital, and colleagues conducted a nationwide audit "to set the standards for routine monitoring ... and to assist in prioritizing efforts to improve the effectiveness of screening programs."

Their findings appear in the Journal of the National Cancer Institute.

The researchers identified 1,230 women with cervical cancer reported to the Swedish Cancer Registry from 1999 through 2001, and randomly selected from the general population 6124 similar subjects without cancer. Screening histories were reviewed for a 6-year period using the National Cervical Cancer Screening Register.

Compared with women who had been screened at the recommended intervals, those who had not were 2.5-times more likely to develop cervical cancer and 4.8-times more likely to develop advanced disease.

There had been some question as to whether women below age 30 should be screened, and if Pap smears could detect all types of cervical cancer. The findings suggest that the answer to both questions is yes.

Still, the investigators say, "the fact that only one case of...cervical cancer occurred in a woman younger than the lower age limit of the screening program supports the view that screening of women younger than 23 is unnecessary."

In a related editorial, Dr. Jack Cuzick, from Wolfson Institute of Preventive Medicine in London, UK, comments that "audits such as the one described by (Andrae's group) need to become routine within screening programs if screening is to achieve its full potential."

"This audit process," he adds, "should be widely emulated for all types of mass screening programs and not only restricted to cervical screening."

SOURCE: Journal of the National Cancer Institute
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