Does screening history explain the ethnic differences in stage at diagnosis of cervical cancer in New Zealand?


Brewer, N; Pearce, N; Jeffreys, M; Borman, B; Ellison-Loschmann, L; (2010) Does screening history explain the ethnic differences in stage at diagnosis of cervical cancer in New Zealand? International journal of epidemiology, 39 (1). pp. 156-165. ISSN 0300-5771 DOI: https://doi.org/10.1093/ije/dyp303

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Abstract

Background There are ethnic disparities in cervical cancer survival in New Zealand. The objectives of this study were to assess the associations of screening history, ethnicity, socio-economic status (SES) and rural residence with stage at diagnosis in women diagnosed with cervical cancer in New Zealand during 1994-2005. Methods The 2323 cases were categorized as 'ever screened' if they had had at least one smear prior to 6 months before diagnosis, and as 'regular screening' if they had had no more than 36 months between any two smears in the period 6-114 months before diagnosis. Logistic regression was used to estimate the associations of screening history, ethnicity, SES and urban/rural residence with stage at diagnosis. Results The percentages 'ever screened' were 43.3% overall, 24.8% in Pacific, 30.5% in Asian, 40.6% in M (a) over bar ori and 46.1% in 'Other' women. The corresponding estimates for 'regular screening' were 14.0, 5.7, 7.8, 12.5 and 15.3%. Women with 'regular screening' had a lower risk of late stage diagnosis [odds ratio (OR) 0.16, 95% confidence interval (CI) 0.10-0.26], and the effect was greater for squamous cell carcinoma (OR 0.12, 95% CI 0.07-0.23) than for adenocarcinoma (OR 0.32, 95% CI 0.13-0.82). The increased risk of late-stage diagnosis (OR 2.72, 95% CI 1.99-3.72) in M (a) over bar ori (compared with 'Other') women decreased only slightly when adjusted for screening history (OR 2.45, 95% CI 1.77-3.39). Conclusions Over half of cases had not been 'ever screened'. Regular screening substantially lowered the risk of being diagnosed at a late stage. However, screening history does not appear to explain the ethnic differences in stage at diagnosis.

Item Type: Article
Keywords: Female, Humans, Neoplasm Staging, New Zealand, epidemiology, Rural Population, statistics & numerical data, Socioeconomic Factors, Uterine Cervical Neoplasms, diagnosis, ethnology, mortality, Vaginal Smears, statistics & numerical data
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 19808843
Web of Science ID: 274491000026
URI: http://researchonline.lshtm.ac.uk/id/eprint/1797

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