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Published on : Feb 24, 2014
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Slide 1 - Cervical Cancer in California Janet Bates, MD MPH Research Program Director Research and Surveillance Program California Cancer Registry
Slide 2 - Overview Decline in cervical cancer mortality: a success story Cervical cancer burden in California Guidelines for cervical cancer screening and evaluation of abnormal Pap tests guidelines
Slide 3 - Cervical Cancer Mortality Rates, U.S., 1946-1984 Source: Program for Improving Clinical Pap Smear Programs and Management, Office of Population Affairs, DHHS, 1987.
Slide 4 - Cervical cancer in California In 2006 expect that 1550 new cases of invasive cervical cancer will be diagnosed among California women 400 California women will die from cervical cancer
Slide 5 - Ten leading causes of cancer incidence and mortality among females, California, 2002
Slide 6 - Ten most common cancer sites diagnosed by race/ethnicity, California, 1999-2003 Source: California Cancer Registry, April 2006
Slide 7 - Ten most common cancer sites diagnosed by race/ethnicity, California, 1999-2003 Source: California Cancer Registry, April 2006
Slide 8 - Cervical cancer incidence trends by race/ethnicity, California, 1988-2003 Source: California Cancer Registry, April 2006
Slide 9 - Cervical cancer incidence trends by race/ethnicity, California, 1988-2003 Source: California Cancer Registry, April 2006
Slide 10 - Cervical cancer incidence trends: Asian subgroups, 1988-2001
Slide 11 - Cervical cancer mortality trends, by race/ethnicity, California, 1988-2003 Source: California Cancer Registry
Slide 12 - Cervical cancer mortality trends, by race/ethnicity, California, 1988-2003 Source: California Cancer Registry
Slide 13 - Cervical cancer five-year age-adjusted incidence rates by race/ethnicity, California, 1998-2002 Source: California Cancer Registry
Slide 14 - Cervical cancer five-year age-adjusted incidence rates, by socioeconomic status, California, 1998-2002 Source: California Cancer Registry
Slide 15 - Cervical cancer five-year age-adjusted incidence rates by race/ethnicity and SES quintile, California, 1998-2002 Source: California Cancer Registry
Slide 16 - Cervical cancer risk factors Unprotected sex Multiple sexual partners History of abnormal Pap test History of cervical cancer/pre-cancerous cervical lesions Immunocompromised Smoking Early age of intercourse Poverty
Slide 17 - Screening for cervical cancer in California
Slide 18 - Women reporting ever having a Pap test by race/ethnicity, California, 1990-2004 Source: Behavioral Risk Factor Surveillance System (BRFSS)
Slide 19 - Percentage of California women without a hysterectomy reporting a recent Pap test (within past 3 years) Source: 2003 California Health Interview Survey
Slide 20 - Cervical cancer screening disparities Regular Pap testing is less frequent among: Immigrants Older women Low-income women Uninsured women Women without a primary source of health care
Slide 21 - Pap Screening: When to Start 3 years after onset of vaginal intercourse, no later than age 21 Annually until age 30 (or every 2 years w/ liquid cytology) At age 30, women with 3 consecutive satisfactory normal Paps can be screened every 2-3 years American Cancer Society Consensus Guidelines, 2002
Slide 22 - Terminology for abnormal Pap tests ASC-US = Atypical squamous cells of undetermned significance LSIL = Low-grade squamous intraepithelial lesion ASC-H = atypical squamous cells – cannot excluded high grade intraepithelial lesion HSIL = high-grade intraepithelial lesion
Slide 23 - 2001 Guidelines for the Management of Abnormal Paps JAMA 2001;287:2120-9
Slide 24 - HSIL 300,000 CA 15,000 LSIL 1,000,000 ASC-US 2,000,000 Modified from Hildesheim, A., National Cancer Institute Estimated Annual Abnormal Pap Tests, U.S.
Slide 25 - Summary Cervical cancer incidence and mortality have declined dramatically after pap test use became widespread Disparities persist, with highest incidence rates among Hispanic women and highest mortality rates among non-Hispanic black women
Slide 26 - Summary Highest incidence is found among the poorest women Pap test utilization varies by race/ethnicity, socioeconomic factors, immigrant status
Slide 27 - Resources California Cancer Registry www.ccrcal.org California Health Interview Survey www.askchis.com