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IJE Advance Access published online on October 6, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp303
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.

Does screening history explain the ethnic differences in stage at diagnosis of cervical cancer in New Zealand?

Naomi Brewer1,*, Neil Pearce1, Mona Jeffreys2, Barry Borman1 and Lis Ellison-Loschmann1

1Centre for Public Health Research, Massey University, Wellington, New Zealand.
2Department of Social Medicine, University of Bristol, Bristol, UK.

*Corresponding author. Centre for Public Health Research, Massey University, Wellington Campus, Private Box 756, Wellington, 6140 New Zealand. E-mail: n.brewer{at}massey.ac.nz


  Abstract

Background There are ethnic disparities in cervical cancer survival in New Zealand. The objectives of this study were to assess the associations of screening history, ethnicity, socio-economic status (SES) and rural residence with stage at diagnosis in women diagnosed with cervical cancer in New Zealand during 1994–2005.

Methods The 2323 cases were categorized as ‘ever screened’ if they had had at least one smear prior to 6 months before diagnosis, and as ‘regular screening’ if they had had no more than 36 months between any two smears in the period 6–114 months before diagnosis. Logistic regression was used to estimate the associations of screening history, ethnicity, SES and urban/rural residence with stage at diagnosis.

Results The percentages ‘ever screened’ were 43.3% overall, 24.8% in Pacific, 30.5% in Asian, 40.6% in Maori and 46.1% in ‘Other’ women. The corresponding estimates for ‘regular screening’ were 14.0, 5.7, 7.8, 12.5 and 15.3%. Women with ‘regular screening’ had a lower risk of late stage diagnosis [odds ratio (OR) 0.16, 95% confidence interval (CI) 0.10–0.26], and the effect was greater for squamous cell carcinoma (OR 0.12, 95% CI 0.07–0.23) than for adenocarcinoma (OR 0.32, 95% CI 0.13–0.82). The increased risk of late-stage diagnosis (OR 2.72, 95% CI 1.99–3.72) in Maori (compared with ‘Other’) women decreased only slightly when adjusted for screening history (OR 2.45, 95% CI 1.77–3.39).

Conclusions Over half of cases had not been ‘ever screened’. Regular screening substantially lowered the risk of being diagnosed at a late stage. However, screening history does not appear to explain the ethnic differences in stage at diagnosis.

Keywords New Zealand, screening, uterine cervical neoplasms

Accepted 13 August 2009


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