HEALTH NEWS

It is not consistent to stop screening women after age 50 because the risk of cervical cancer - even after several negative smear results - is similar to that at younger ages, concludes a study published on bmj.com.
Ever since the first organised cervical screening programmes started in Europe more than 40 years ago, discussion about the upper age limit for effective screening has been ongoing.
Evidence suggests that repeating smear tests in women aged 60-65 whose previous tests have been normal has little, if any, benefit, and some researchers have proposed that the age limit should be lowered to 50.
So researchers at the Erasmus Medical Center in The Netherlands and the University of Copenhagen in Denmark compared levels of cervical cancer after several negative smears at different ages.
Using data from a national cervical cancer register in The Netherlands (PALGA), they identified 219,000 women aged 45-54 years and 445,000 women aged 30-44 years after their third consecutive negative smear test. The women were then tracked for 10 years, during which time cases of cervical cancer were recorded.
During follow-up, both age groups had similar levels of screening. After 10 years, the incidence of cervical cancer was similar in both groups (41 per 100,000 in the younger group and 36 per 100,000 in the older group), suggesting that among well-screened women without previous abnormalities the risk of developing cervical cancer is independent of age.
Based on these results, it is reasonable to assume that after several consecutive negative results the screening efficiency in terms of detection and prevention of cervical cancer is at the same level around age 50 as it is at younger ages, say the authors.
Whether the observed incidence rates warrant continued screening should be determined by subsequent analysis, but the study suggests that it would not be consistent to stop screening these women while not also relaxing the screening policy for younger women with similar screening histories.
In this respect, our study lends support to the current cervical cancer screening guidelines in England and other developed countries, which do not discriminate women by age up to 65 years, they conclude.
In an accompanying editorial, Björn Strander, Director of cervical screening at Sahlgren's University Hospital in Sweden, suggests we have to pay close attention to developments in invasive cancer in age groups above the cut-off point for screening and be prepared to adjust the screening ages as we learn more.
With modern computer technology we could tailor screening invitations to the individual, he says. Resources could then be allocated away from women who would not benefit from additional smears within a certain number of years to those who would, and the question of whether to screen above the age of 60 could then be answered - yes, for those who benefit the most from it.

Immigrant women in Ontario are not screened for cervical cancer as often as native-born Canadians, with the lowest rates being among older, poorer South Asians, new research shows.
Only one in five -- 21.9 per cent -- of South Asian immigrants over the age of 50 living in low-income neighbourhoods had had a recent Pap test, according to a study led by doctors at St. Michael's Hospital.
In contrast, 79 per cent of Canadian-born women living in the highest-income neighbourhoods and who had a primary care doctor were up-to-date with their cervical cancer screening. In Canada, federal and provincial guidelines call for a Pap test at least once every three years.
The study compared cervical cancer screening rates for immigrant and Canadian-born women living in urban areas of Ontario between 2006 and 2008. Overall, of the 2.9 million women ages 18 to 69 whose medical billing records were compared, 61.3 per cent were up-to-date.
The study, led by family physician Dr. Aisha Lofters, appeared in a recent edition of the journal Preventative Medicine.
"We need to reach out to the South Asian immigrant community and let them know the importance of the test," said Dr. Lofters, who is with the hospital's Center for Research on Inner City Health.
Dr. Lofters said the low screening rates for poorer, older South Asians may have a lot to do with culture and their experience in their homelands. Cervical cancer screening rates in many South Asian countries are quite low -- only 1 per cent in Bangladesh, even for those in the highest income strata.
"These women may not be coming from a culture where this is normal or practiced protocol," she said. "Some women were not even aware that they needed the test."
The length of time spent in Canada had little effect on a woman's screening rates. Even those who had been living in Canada for 10 or more years had rates similar to those who had recently immigrated, suggesting low patterns continue after immigration. Many of the women may be reluctant to see male doctors, Dr. Lofters said.
Cervical cancer is the second most common cancer among women worldwide. Rates are almost twice as high in the less developed world than the more developed world, where more people have Pap tests. The World Health Organization estimates that 95 per cent of women in less developed countries have never been screened and that screening every 5 to 10 years could significantly reduce deaths worldwide from cervical cancer.

Gynaecological screening tests for cervical cancer have been available to all women in Sweden for almost four decades. Despite this, many immigrant women have a higher risk of developing the disease than Swedish-born women, according to a new study from Karolinska Institutet.
This is particularly the case for women from other Nordic countries and Central America, the differences being linked to, amongst other things, variation in the incidence of the Human Pappiloma Virus (HPV) around the world. HPV is a significant risk factor for cervical cancer.
"But there are other risk factors too, such as smoking, sexual habits and not taking screening tests, which make it interesting to compare cervical cancer rates between different groups of immigrant women in Sweden and native Swedes," says Professor Pär Sparén, who has led the study at the Department of Medical epidemiology and Biostatistics.
The study included more than 750,000 resident immigrant women from different countries, all of whom are registered on Karolinska Institutet’s national database of women’s health. During the period under study (1968 to 2004) there were 1,991 cases of cervical cancer in this group. Compared with Swedish-born women in general, this represents a slightly higher risk of developing the disease (10 per cent). Also, the incidence proportion of cervical cancer amongst women who had immigrated to Sweden was lower than amongst women in their respective countries.
However, the study also shows wide variation between the immigrant groups. Women from east Africa generally were five times less likely to develop cervical cancer than Swedish-born women, while women from southern Asia were half as likely. Conversely, the risk was much higher for women from Norway and Denmark (70 per cent and 80 per cent, respectively) and Central America (150 per cent).
Professor Sparén’s team also observed that the risk of cervical cancer increased with the age of entry into Sweden, but declined during their period of residency in their new homeland. Professor Sparén believes that his findings are important for the more effective prevention of cervical cancer through, for example, targeted screening programmes.
"We need to introduce targeted screening for the prevention of cervical cancer amongst high-risk groups, particularly women over 50 during their first ten years in Sweden," he says.
The study, which was funded with a grant from the Swedish Council for Working Life and Social Research (FAS) and the National Health Care Sciences Postgraduate School at Karolinska Institutet, was a joint project with Tehran University of Medical Sciences in Iran and Mälardalen University.