Impact of organized and opportunistic Pap testing on the risk of cervical cancer in young women – A case-control study from Finland
Abstract Objective Effectiveness of organized cervical cancer screening has been shown in several studies. However, screening among women aged Methods In the Finnish Cancer Registry there were 284 cervical cancer cases diagnosed and tested below the age of 40 in 2004–2009. Screening histories and data on opportunistic testing for these women and their 1698 age-matched controls were derived from databases of the Mass Screening Registry and The National Institute for Health and Welfare from 1997 onward. OR's and 95% CI's for the association of cervical cancer diagnosis and participation in organized screening and opportunistic testing were estimated using unconditional logistic regression. Results were corrected for self-selection bias and attendance rate. Results Among women aged under 25, OR of cervical cancer for any Pap test taken 0.5–5.5years before diagnosis was 1.25 (95% CI 0.46–3.43). Attending only organized screening at age 25–39 resulted in OR 0.52 (0.36–0.77), attending only opportunistic testing in OR 0.86 (0.60–1.25) and attending both in OR 0.48 (0.29–0.79). Conclusion Opportunistic testing showed no clear additional benefit on preventing cervical cancer. The study also supports findings on a smaller effect of screening in younger age groups. Highlights The effect of screening on the risk of cervical cancer diminishes by decreasing age. Data on opportunistic testing was also available. Under the age of 25 Pap testing appeared to have no impact. A clear preventive effect was observed among women tested at age 35–39years. Organized screening is more effective than opportunistic testing.
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