Temporal Patterns of Cervical Cancer Screening Among Danish Women 55 Years and Older Diagnosed With Cervical Cancer

Objective: The aim of the study was to describe the screening history in postmenopausal women diagnosed with cervical cancer during 1990-2013 by age and screening period. Materials and Methods : This hospital-based cohort study included women 55 years and older diagnosed with cervical cancer at Aarhus University Hospital, Denmark, during 1990-2013. Information on their previous history of cervical cancer screening was obtained from the Danish Pathology Databank. Results: Overall, 47.0% (95% CI = 42.6-51.4) had no record of screening before their cervical cancer diagnosis. This proportion declined over calendar time from 69.8% (95% CI = 61.4-77.3) in 1990-1994 to 20.0% (95% CI = 12.7-29.2) in 2010-2013 and increased by age from 22.5% (95% CI = 14.6-32.0) in women aged 55 to 59 years to 63.2% (95% CI = 49.3-75.6) in women 80 years and older. Cases living in the organized screening era (i.e., birth cohorts 1943-1960) were more likely to have a record of screening than women in the preorganized screening era (i.e., birth cohorts 1901-1942) (p < .001). Of all cases, 17.7% (n = 91) had a record of screening within 5 years of diagnosis and the proportion was highest in the most recent periods and in women aged 55 to 64 years. Of cases with a record of screening within 5 years, 84.6% (95% CI = 14.5-21.2) had a normal cytology result, whereas only 8.8% (95% CI = 2.9-14.7) had high-grade squamous intraepithelial lesion or worse. Conclusions: Cervical cancer in older women may partly be attributed to a lack of screening or due to a failure in screening. However, older women were in general less screened because screening was unavailable.