Research Article| Volume 142, ISSUE 3, P395-400, September 2016

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Case-control study of cervical cancer and gynecologic screening: A SEER-Medicare analysis


      • Population-based case-control study utilizing SEER-Medicare data
      • Cervical cancer screening reduces the risk of invasive cervical cancer in women over 65 years old.
      • Risk is more greatly reduced in women aged 65–74 and when controlling for hysterectomy.



      To determine the association between Pap smear and pelvic examination screenings and the development of invasive cervical cancer in a Medicare population using a matched case-control design.


      Matched case-control data sets were constructed from the SEER-Medicare database that links the Surveillance Epidemiology End Results (SEER) cancer registry data and Medicare enrollment and claims data of subjects who received care between the years 1991 and 1999 aged 65 years or older. The study identified 1267 cervical cancer cases. Controls (N = 10.137) were matched to cases representing up to eight matched controls (on age and registry geographic location) for a single case. The association between gynecologic screenings and the development of invasive cervical cancer was ascertained using conditional logistic regression analysis.


      Having had a Pap smear during the PIDP (pre-invasive detectable phase – 2 to 7 years prior to diagnosis) was significantly negatively associated with the development of invasive cervical cancer (OR = 0.64, 95% CI = 0.53–0.78) which was reduced after taking into account the estimated prevalence of hysterectomy among controls (OR = 0.38, 95% CI = 0.32–0.46). The negative association between Pap smear screenings and cervical cancer was strongest for squamous tumors (OR = 0.48, 95% CI = 0.37–0.61). Restricting the subjects to those 72 and over did not affect risk.


      There is a reduction in risk for invasive cervical cancer when women over age 65 are screened. This suggests that cervical cancer screening in the aged population may be beneficial.


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        • Rustagi A.S.
        • Kamineni A.
        • Weiss N.S.
        Point: cervical cancer screening guidelines should consider observational data on screening efficacy in older women.
        Am. J. Epidemiol. 2013; 178: 1020-1022
        • Moyer V.A.
        Screening for cervical cancer: U.S. preventive services task force recommendation statement.
        Ann. Intern. Med. 2012; 156 (W312): 880-891
      1. Obstet. Gynecol. 2012; 120: 1222-1238
        • Peirson L.
        • et al.
        Screening for cervical cancer: a systematic review and meta-analysis.
        Syst. Rev. 2013; 2: 35
        • Elit L.
        Role of cervical screening in older women.
        Maturitas. 2014; 79: 413-420
        • Isidean S.D.
        • Franco E.L.
        Counterpoint: cervical cancer screening guidelines–approaching the golden age.
        Am. J. Epidemiol. 2013; 178 (discussion 1027): 1023-1026
        • Warren J.L.
        • et al.
        Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.
        Med. Care. 2002; 40: IV-3-18
        • Mounib E.
        • Satchi T.
        Paper 230–25 automating the selection of controls in case-control studies.
        in: SAS Users Group 25th Annual International Conference. 2000
        • Weiss N.S.
        Case-control studies of the efficacy of screening tests designed to prevent the incidence of cancer.
        Am. J. Epidemiol. 1999; 149: 1-4
        • Kamineni A.
        • et al.
        Efficacy of screening in preventing cervical cancer among older women.
        Cancer Causes Control. 2013; 24: 1653-1660
        • Rositch A.F.
        • Nowak R.G.
        • Gravitt P.E.
        Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009.
        Cancer. 2014; 120: 2032-2038
        • Andrae B.
        • et al.
        Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden.
        J. Natl. Cancer Inst. 2008; 100: 622-629
        • Andrae B.
        • et al.
        Screening and cervical cancer cure: population based cohort study.
        BMJ. 2012; 344e900
        • Sasieni P.
        • Castanon A.
        • Cuzick J.
        Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data.
        BMJ. 2009; 339: b2968
        • Castanon A.
        • et al.
        Cervical screening at age 50-64 years and the risk of cervical cancer at age 65 years and older: population-based case control study.
        PLoS Med. 2014; 11e1001585
        • Yang B.
        • et al.
        A case-control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women.
        Cancer Causes Control. 2008; 19: 569-576
        • Zappa M.
        • et al.
        Lower protection of cytological screening for adenocarcinomas and shorter protection for younger women: the results of a case-control study in Florence.
        Br. J. Cancer. 2004; 90: 1784-1786
        • Rustagi A.S.
        • et al.
        Cervical screening and cervical cancer death among older women: a population-based, case-control study.
        Am. J. Epidemiol. 2014; 179: 1107-1114
        • Salloum R.G.
        • et al.
        U.S. preventive services task force recommendations and cancer screening among female Medicare beneficiaries.
        J. Women's Health (Larchmt). 2014; 23: 211-217
        • Baay M.F.
        • et al.
        Can cervical cancer screening be stopped at 50? The prevalence of HPV in elderly women.
        Int. J. Cancer. 2004; 108: 258-261
        • Bruni L.
        • et al.
        Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings.
        J. Infect. Dis. 2010; 202: 1789-1799
        • Gravitt P.E.
        • et al.
        A cohort effect of the sexual revolution may be masking an increase in human papillomavirus detection at menopause in the United States.
        J. Infect. Dis. 2013; 207: 272-280
        • Gonzalez P.
        • et al.
        Behavioral/lifestyle and immunologic factors associated with HPV infection among women older than 45 years.
        Cancer Epidemiol. Biomark. Prev. 2010; 19: 3044-3054
        • McDonald T.W.
        • et al.
        Impact of cervical intraepithelial neoplasia diagnosis and treatment on self-esteem and body image.
        Gynecol. Oncol. 1989; 34: 345-349
        • Bell S.
        • et al.
        Psychological response to cervical screening.
        Prev. Med. 1995; 24: 610-616
        • Stiles M.
        • et al.
        Gynecologic issues in geriatric women.
        J. Women's Health (Larchmt). 2012; 21: 4-9
        • Bates C.K.
        • Carroll N.
        • Potter J.
        The challenging pelvic examination.
        J. Gen. Intern. Med. 2011; 26: 651-657
        • Sox H.C.
        Screening for disease in older people.
        J. Gen. Intern. Med. 1998; 13: 434-435