Late-stage
cervical cancer risk factors identified
Women who are elderly, single and uninsured
are more likely to be diagnosed with late-stage cervical cancer despite the
widespread use of the Pap smear as a screening tool, researchers report.
Once the disease has already reached a late stage, or has spread to other
parts of the body, the chance of surviving at least 5 years is anywhere from 8
percent to 50 percent, depending on how far cancer has spread. Women who are
diagnosed early have a more than 90 percent chance of surviving 5 years,
according to the report in the May issue of the Archives of Family Medicine.
The results point to the need for doctors to target certain groups of women
for cervical cancer screening and education, the authors note.
"Stage at diagnosis is the most important prognostic determinant for
invasive cervical cancer," writes Dr. Jeanne M. Ferrante and colleagues from
the University of South Florida in Tampa.
"Increasing Pap smear screening in these women is paramount to
decreasing mortality from cervical cancer," they add.
The investigators found that younger women are more likely to be diagnosed
with cervical cancer before the disease has spread. Each additional year of age
increases the risk of receiving a late-stage diagnosis by 3 percent, the
findings indicate.
Women over age 65 were at greatest risk for late-stage diagnosis, Ferrante
and colleagues found. The team speculates that older women may believe they are
less vulnerable to cervical cancer and do not receive regular Pap smears.
However, the risk of late-stage diagnosis was also higher in women in their 40s
and 50s.
"It might be that as women age past their reproductive years and no
longer need birth control or obstetric care, they may tend to see
obstetrician-gynecologists and family physicians less often for pelvic
examinations and Pap smears," the authors suggest.
The researchers also found that single women were 63 percent more likely to
receive a late-stage diagnosis compared with married women, possibly because
they are less likely to see a gynecologist if they are not sexually active, or
because they lack the encouragement and support to seek medical care after early
symptoms occur.
The authors note that single women also include homosexual women, who may
mistakenly believe they are at low risk for cervical cancer.
Finally, women who lacked health insurance were 60 percent more likely to be
diagnosed with late-stage cervical cancer.
Women enrolled in HMOs were more likely to receive regular Pap smears,
putting them at decreased risk for being diagnosed with cervical cancer at a
late stage. This group was 46 percent less likely to receive a late-stage
diagnosis.
In other findings, race, education, income, smoking status, the presence of
another illness and living in a city did not affect the stage at which a woman
was diagnosed.
"More must be learned about factors affecting stage at diagnosis of
cervical cancer to improve early detection of this potentially preventable and
curable cancer," Ferrante and colleagues conclude.
