Association between screening history and prognosis of cervical carcinoma in situ and invasive cervical cancer: A population-based cohort study.

BACKGROUND

Cervical cancer remains a significant public health challenge worldwide. This study examines the impact of screening history on the prognosis of cervical carcinoma in situ and invasive cervical cancer among Taiwanese women.

METHODS

Data from the National Cervical Cancer Screening Registry and Taiwan Cancer Registry were analyzed, encompassing 13,552 cases of cervical carcinoma in situ and 6853 cases of invasive cervical cancer diagnosed between 2009 and 2013. The study examined the relationship between screening history and five-year cumulative probability of death using the Kaplan-Meier method and Cox regression model, adjusting for factors like age, cancer stage, histological type, urbanization level, and treatment received.

RESULTS

Screening history was an independent prognostic factor for both invasive cervical cancer and cervical carcinoma in situ, even after adjusting for key confounders. Compared to patients diagnosed within six months of a positive screening result, those diagnosed later or with a negative screening had higher post-diagnosis mortality (adjusted hazard ratios [95 % confidence interval]: 1.42 [1.26-1.59] for invasive cervical cancer and 1.74 [0.52-5.83] for cervical carcinoma in situ), while never-screened patients had even higher mortality (1.61 [1.42-1.81] for invasive cervical cancer and 5.62 [1.29-24.51] for cervical carcinoma in situ). More advanced age at diagnosis, certain histological types, and living in less urbanized areas correlated with an increased risk of post-diagnosis death. Additionally, the absence of treatment post-diagnosis was significantly associated with worse outcomes.

CONCLUSION

Screening history is a crucial independent prognostic factor for cervical carcinoma in situ and invasive cervical cancer. Patients with a recent positive screening result have a markedly better prognosis than those diagnosed later, those with negative screenings, or unscreened individuals. This study emphasizes the importance of regular and timely cervical cancer screenings in improving prognosis and underscores the need to enhance awareness and accessibility of screening programs.