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. 1992 Oct;42(363):435–438.

Risk targeting in cervical screening: a new look at an old problem.

C E Wilkinson 1, T J Peters 1, I M Harvey 1, N C Stott 1
PMCID: PMC1372236  PMID: 1466924

Abstract

In the face of continuing debate about the level of effectiveness of the United Kingdom cervical cytology screening programme in preventing cervical cancer, more precise targeting of high risk groups might offer a means of enhancing its efficiency. Broad risk targeting is already practised by screening only sexually active women aged 20 to 65 years. This paper describes a risk scoring system constructed from the available literature and designed to be used by primary care health professionals and patients. The system involves four independent risk factors: educational level, current smoking habit, years of oral contraceptive use and number of sexual partners. Since the objective is simply to identify women at relatively high risk, inclusion of a factor neither requires nor implies causality. The next steps are to study the feasibility of putting the scale to practical use and to investigate its predictive value in a prospective evaluation.

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Selected References

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  1. Alberman E. D., Goldstein H. The "at risk" register: a statistical evaluation. Br J Prev Soc Med. 1970 Aug;24(3):129–135. doi: 10.1136/jech.24.3.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alexander F. E., Roberts M. M., Huggins A., Muir B. B. Use of risk factors to allocate schedules for breast cancer screening. J Epidemiol Community Health. 1988 Jun;42(2):193–199. doi: 10.1136/jech.42.2.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anderson G. H., Boyes D. A., Benedet J. L., Le Riche J. C., Matisic J. P., Suen K. C., Worth A. J., Millner A., Bennett O. M. Organisation and results of the cervical cytology screening programme in British Columbia, 1955-85. Br Med J (Clin Res Ed) 1988 Apr 2;296(6627):975–978. doi: 10.1136/bmj.296.6627.975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brinton L. A., Hamman R. F., Huggins G. R., Lehman H. F., Levine R. S., Mallin K., Fraumeni J. F., Jr Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst. 1987 Jul;79(1):23–30. [PubMed] [Google Scholar]
  5. Clarke E. A., Hatcher J., McKeown-Eyssen G. E., Lickrish G. M. Cervical dysplasia: association with sexual behavior, smoking, and oral contraceptive use? Am J Obstet Gynecol. 1985 Mar 1;151(5):612–616. doi: 10.1016/0002-9378(85)90149-8. [DOI] [PubMed] [Google Scholar]
  6. Clarke E. A., Morgan R. W., Newman A. M. Smoking as a risk factor in cancer of the cervix: additional evidence from a case-control study. Am J Epidemiol. 1982 Jan;115(1):59–66. doi: 10.1093/oxfordjournals.aje.a113279. [DOI] [PubMed] [Google Scholar]
  7. Elkind A., Eardley A., Thompson R., Smith A. How district health authorities organise cervical screening. BMJ. 1990 Oct 20;301(6757):915–918. doi: 10.1136/bmj.301.6757.915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. English D. R., Armstrong B. K. Identifying people at high risk of cutaneous malignant melanoma: results from a case-control study in Western Australia. Br Med J (Clin Res Ed) 1988 May 7;296(6632):1285–1288. doi: 10.1136/bmj.296.6632.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hakama M., Pukkala E., Saastamoinen P. Selective screening: theory and practice based on high-risk groups of cervical cancer. J Epidemiol Community Health. 1979 Dec;33(4):257–261. doi: 10.1136/jech.33.4.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hakama M., Pukkala E. Selective screening for cervical cancer. Experience of the Finnish mass screening system. Br J Prev Soc Med. 1977 Dec;31(4):238–244. doi: 10.1136/jech.31.4.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Harris R. W., Brinton L. A., Cowdell R. H., Skegg D. C., Smith P. G., Vessey M. P., Doll R. Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri. Br J Cancer. 1980 Sep;42(3):359–369. doi: 10.1038/bjc.1980.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ismail S. M., Colclough A. B., Dinnen J. S., Eakins D., Evans D. M., Gradwell E., O'Sullivan J. P., Summerell J. M., Newcombe R. G. Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia. BMJ. 1989 Mar 18;298(6675):707–710. doi: 10.1136/bmj.298.6675.707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jordan J. A. Minor degrees of cervical intraepithelial neoplasia. BMJ. 1988 Jul 2;297(6640):6–6. doi: 10.1136/bmj.297.6640.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. La Vecchia C., Franceschi S., Decarli A., Fasoli M., Gentile A., Parazzini F., Regallo M. Sexual factors, venereal diseases, and the risk of intraepithelial and invasive cervical neoplasia. Cancer. 1986 Aug 15;58(4):935–941. doi: 10.1002/1097-0142(19860815)58:4<935::aid-cncr2820580422>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  15. La Vecchia C., Franceschi S., Decarli A., Fasoli M., Gentile A., Tognoni G. Cigarette smoking and the risk of cervical neoplasia. Am J Epidemiol. 1986 Jan;123(1):22–29. doi: 10.1093/oxfordjournals.aje.a114220. [DOI] [PubMed] [Google Scholar]
  16. Macgregor J. E., Moss S. M., Parkin D. M., Day N. E. A case-control study of cervical cancer screening in north east Scotland. Br Med J (Clin Res Ed) 1985 May 25;290(6481):1543–1546. doi: 10.1136/bmj.290.6481.1543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McCormick J. S. Cervical smears: a questionable practice? Lancet. 1989 Jul 22;2(8656):207–209. doi: 10.1016/s0140-6736(89)90384-x. [DOI] [PubMed] [Google Scholar]
  18. McIndoe W. A., McLean M. R., Jones R. W., Mullins P. R. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol. 1984 Oct;64(4):451–458. [PubMed] [Google Scholar]
  19. Nasiell K., Nasiell M., Vaćlavinková V. Behavior of moderate cervical dysplasia during long-term follow-up. Obstet Gynecol. 1983 May;61(5):609–614. [PubMed] [Google Scholar]
  20. Parazzini F., Hildesheim A., Ferraroni M., La Vecchia C., Brinton L. A. Relative and attributable risk for cervical cancer: a comparative study in the United States and Italy. Int J Epidemiol. 1990 Sep;19(3):539–545. doi: 10.1093/ije/19.3.539. [DOI] [PubMed] [Google Scholar]
  21. Peritz E., Ramcharan S., Frank J., Brown W. L., Huang S., Ray R. The incidence of cervical cancer and duration of oral contraceptive use. Am J Epidemiol. 1977 Dec;106(6):462–469. doi: 10.1093/oxfordjournals.aje.a112492. [DOI] [PubMed] [Google Scholar]
  22. Raffle A. E., Alden B., Mackenzie E. F. Six years' audit of laboratory workload and rates of referral for colposcopy in a cervical screening programme in three districts. BMJ. 1990 Oct 20;301(6757):907–911. doi: 10.1136/bmj.301.6757.907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rasbridge S. A., Jenkins D., Tay S. K. A histological and immunohistological study of cervical intraepithelial neoplasia in relation to recurrence after local treatment. Br J Obstet Gynaecol. 1990 Mar;97(3):245–250. doi: 10.1111/j.1471-0528.1990.tb01789.x. [DOI] [PubMed] [Google Scholar]
  24. Roberts M. M. Breast screening: time for a rethink? BMJ. 1989 Nov 4;299(6708):1153–1155. doi: 10.1136/bmj.299.6708.1153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Robertson J. H., Woodend B. E., Crozier E. H., Hutchinson J. Risk of cervical cancer associated with mild dyskaryosis. BMJ. 1988 Jul 2;297(6640):18–21. doi: 10.1136/bmj.297.6640.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Schneider A., Sawada E., Gissmann L., Shah K. Human papillomaviruses in women with a history of abnormal Papanicolaou smears and in their male partners. Obstet Gynecol. 1987 Apr;69(4):554–562. [PubMed] [Google Scholar]
  27. Shaper A. G., Pocock S. J., Phillips A. N., Walker M. Identifying men at high risk of heart attacks: strategy for use in general practice. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):474–479. doi: 10.1136/bmj.293.6545.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Singer A., Walker P. G., McCance D. J. Genital wart virus infections: nuisance or potentially lethal? Br Med J (Clin Res Ed) 1984 Mar 10;288(6419):735–737. doi: 10.1136/bmj.288.6419.735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Slater D. National cervical screening programme. BMJ. 1990 Oct 20;301(6757):887–888. doi: 10.1136/bmj.301.6757.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Smith A., Elkind A., Eardley A. Making cervical screening work. BMJ. 1989 Jun 24;298(6689):1662–1664. doi: 10.1136/bmj.298.6689.1662. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Tidy J. A., Parry G. C., Ward P., Coleman D. V., Peto J., Malcolm A. D., Farrell P. J. High rate of human papillomavirus type 16 infection in cytologically normal cervices. Lancet. 1989 Feb 25;1(8635):434–434. doi: 10.1016/s0140-6736(89)90023-8. [DOI] [PubMed] [Google Scholar]
  32. Tidy J. A., Vousden K. H., Farrell P. J. Relation between infection with a subtype of HPV16 and cervical neoplasia. Lancet. 1989 Jun 3;1(8649):1225–1227. doi: 10.1016/s0140-6736(89)92329-5. [DOI] [PubMed] [Google Scholar]
  33. Vessey M. P., Lawless M., McPherson K., Yeates D. Neoplasia of the cervix uteri and contraception: a possible adverse effect of the pill. Lancet. 1983 Oct 22;2(8356):930–934. doi: 10.1016/s0140-6736(83)90451-8. [DOI] [PubMed] [Google Scholar]
  34. Young L. S., Bevan I. S., Johnson M. A., Blomfield P. I., Bromidge T., Maitland N. J., Woodman C. B. The polymerase chain reaction: a new epidemiological tool for investigating cervical human papillomavirus infection. BMJ. 1989 Jan 7;298(6665):14–18. doi: 10.1136/bmj.298.6665.14. [DOI] [PMC free article] [PubMed] [Google Scholar]

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