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Obstetrics & Gynecology 2002;100:79-86
© 2002 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Decreased Incidence of Cervical Cancer in Medicare-Eligible California Women

Terri L. Cornelison, MD, PhD, Fredrick J. Montz, MD, KM, Robert E. Bristow, MD, Betty Chou, MD, Alessandro Bovicelli, MD and Scott L. Zeger, PhD

From The Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics, and Department of Biostatistics, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and Division of Cancer Prevention, National Cancer Institutes, Bethesda, Maryland.

Address reprint requests to: Fredrick J. Montz, MD, KM, The Johns Hopkins Medical Institutions, Departments of Gynecology and Obstetrics, 600 North Wolfe Street, Houck 248, Baltimore, MD 21210; E-mail: fmontz{at}jhmi.edu.

OBJECTIVE: To determine if the incidence of invasive cervical cancer relative to carcinoma in situ decreased in Medicare-eligible women.

METHODS: A retrospective cohort was amassed from the California Cancer Registry database. The hypothesis was prospectively specified. Mean ratio of invasive (International Federation of Gynecology and Obstetrics Stages I–IV) to in situ cervical carcinoma in 1988–1990 versus 1991–1995 was stratified by age (24 or younger, 25–44, 45–64, 65 or older) and race (all races, whites, blacks, Hispanics, Asian/Pacific Islanders).

RESULTS: The mean ratio of invasive to in situ cervical cancer incidence for women at least 65 years old was lower in 1991–1995 compared with 1988–1990 (P < .001, 95% confidence interval 0.893, 0.954); and had decreased more than observed for women aged 45–64 and 25–44, for all races combined, and for white women. The decreased ratio of invasive to in situ cancer for blacks, Hispanics, and Asian/Pacific Islanders at least 65 years old was no different than the decreased ratio in younger women.

CONCLUSION: In California, in the 5 years after the 1990 change in Medicare funding statutes for cervical cytology screening, the ratio of invasive cervical cancer to in situ disease decreased more in Medicare-eligible patients than in younger women.






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