Understanding cervical cancer after the age of routine screening: Characteristics of cases, treatment, and survival in the United States.

Autor: Lichter KE; Department of Radiation Oncology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America., Levinson K; Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, United States of America., Hammer A; Department of Obstetrics and Gynecology, Gødstrup Hospital, Gl. Landevej 61, 7400 Herning, Denmark; Department of Clinical Medicine, Palle Juul Jensens Boulevard 99, Aarhus University, Denmark., Lippitt MH; Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, United States of America., Rositch AF; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America. Electronic address: arositch@jhu.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2022 Apr; Vol. 165 (1), pp. 67-74. Date of Electronic Publication: 2022 Feb 01.
DOI: 10.1016/j.ygyno.2022.01.017
Abstrakt: Objective: Given that cervical cancer incidence rates do not decline in women >65, there is generally limited screening, and these women have a poor prognosis, it is imperative to better understand this population. We aim to describe the characteristics, treatment, and survival of women >65 diagnosed with cervical cancer.
Methods: SEER-Medicare 2004-2013 data was used to describe 2274 patients >65 diagnosed with cervical cancer. Five-year cancer-specific survival was estimated using the Kaplan-Meier method. Multivariable Poisson and Cox regression analyses identified characteristics associated with treatment and mortality.
Results: The median age was 76.1 years, with nearly one-third of cases occurring in women >80 years. Most patients were non-Hispanic White (64.8%), had comorbidity scores ≥ 1 (53.9%) and squamous histology (66.3%). Most women were diagnosed at stage II or higher (62.7%), including nearly one-quarter at Stage IV (23.1%). Nearly 15% of patients were not treated (14.6%). Lack of treatment was associated with oldest age (>80), comorbidity scores ≥3, and stage IV disease. Five-year cancer-specific survival was 50%. Increasing age and stage at diagnosis were significantly associated with lower cancer-specific survival whereas treatment was strongly associated with increased survival.
Conclusion: Most women >65 with cervical cancer are diagnosed with locally advanced or metastatic disease and many do not receive treatment. Survival is improved with early-stage diagnosis and treatment. These findings, coupled with the fact that women >65 constitute an increasing proportion of the population, highlight the need to re-evaluate screening and treatment practices in this population to detect cervical cancer at earlier stages and increase survival.
Novelty and Impact Statement: In SEER-Medicare linked data from 2004 to 2013, most women >65 with cervical cancer were diagnosed with locally advanced or metastatic disease. Both receipt of treatment and survival decreased with increasing age. These findings, coupled with the fact that women aged >65 constitute an increasing proportion of the population, highlight the need to re-evaluate screening and treatment practices in older women to detect cervical cancer at earlier stages and increase survival.
Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: