Nursing Mother, Working Mother

• Publisher: Elsevier Science
• Year: 1999
• Weight: 55 KB
• Volume: 44
• Category: Article
• ISSN: 0091-2182
• DOI: 10.1016/s0091-2182(99)00021-x

✦ Synopsis

They then compared findings with results from other screening programs.

The authors were most interested in high-grade precancerous changes (CIN II, CIN III/carcinoma in situ [CIS], and invasive cancer). Rates of all grades of CIN and invasive cancer were calculated as number of cases with final histologic diagnoses of CIN (CIN I, II, III/CIS) and invasive cancer per 1,000 Papanicolaou smears performed for first and subsequent screening cycles. They calculated the positive predictive value (PPV) of high-grade abnormal Papanicolaou smears (eg, the number of Papanicolaou smears with high-grade squamous intraepithelial lesion or squamous carcinoma that resulted in biopsy confirmed CIN II, CIN III, or invasive cancer divided by the number of high grade abnormal tests [emphasis added]).

Data were analyzed on 312,858 women aged 18 years or older who received one or more Papanicolaou smears, and follow-up if indicated, from October 1991 to June 1995. Approximately 25% of the women were younger than 30 years, and more than half were aged 40 or older. Slightly less than half of the women were of racial and ethnic minorities including Hispanic, African American, American Indian, and Asian. During the first screening cycle, 3.8% of Papanicolaou smears were abnormal (squamous intraepithelial lesion [SIL] or squamous cell cancer) and proportions of abnormal results decreased with increasing age. The most frequently occurring abnormality during both first and subsequent cycles was CIN I; rates of CIN I were higher during subsequent cycles for women aged 30 and older. Rates of invasive cancer did not follow this age trend: cancer rates increased with age during the first screening cycle and peaked among women between ages 50 and 64. Although individual rates of CIN varied somewhat by age, overall rates of CIN II declined steadily with increasing age. The age-adjusted rate of CIN II or worse (CIN IIϩ) for women having their first program Papanicolaou smear was 7.4 per 1,000. Women younger than age 30 had the highest rate of CIN IIϩ (19 per 1,000) and women aged 40 and older had rates less than one third that. PPV was 56% for CIN II/III and 3.7% for invasive cancer. There were not enough cases to calculate PPV for invasive cancer by age. PPVs for CIN II and III were highest in the first screening cycle among women in their 30's.

Overall, 150 women were diagnosed with invasive cervical cancer during the review period, and almost three quarters of the invasive cancers were diagnosed among women older than 40 years of age. The cancer detection rate was 0.5 per 1,000 Papanicolaou smears. Of the 150 invasive cancers diagnosed, 54% were classified as local disease.

The authors noted the dual nature of cervical neoplasia vis-a `-vis age: precancerous conditions in younger women and invasive cancer in older women. The results