Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016

Ming Li, David Roder, Lisa Whop, Abbey Diaz, Peter D. Baade, Julia ML Brotherton, Karen CANFELL, Joan Cunningham, Gail Garvey, Suzanne Moore, Dianne L. O'Connell, Patricia Valery, John Condon

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women.


Methods: Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women.


Results: Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher.


Conclusions: Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.

LanguageEnglish
Pages1-9
Number of pages9
JournalJournal of Medical Screening
DOIs
StateE-pub ahead of print - 12 Nov 2018

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South Australia
Odds Ratio
Confidence Intervals
Uterine Cervical Neoplasms
Cell Biology
Registries
Mortality
Hospital Records
Vulnerable Populations

Cite this

Li, Ming ; Roder, David ; Whop, Lisa ; Diaz, Abbey ; Baade, Peter D. ; Brotherton, Julia ML ; CANFELL, Karen ; Cunningham, Joan ; Garvey, Gail ; Moore, Suzanne ; O'Connell, Dianne L. ; Valery, Patricia ; Condon, John. / Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016. In: Journal of Medical Screening. 2018 ; pp. 1-9
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title = "Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016",
abstract = "Objective: Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. Methods: Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. Results: Of 1,676,141 linkable cytology tests, 5.8{\%} were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14{\%} (95{\%} confidence interval 5–24{\%}) higher, and the relative risk of a high grade cytological abnormality was 61{\%} (95{\%} confidence interval 44–79{\%}) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76{\%} (95{\%} confidence interval 46–113{\%}) higher. Conclusions: Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.",
author = "Ming Li and David Roder and Lisa Whop and Abbey Diaz and Baade, {Peter D.} and Brotherton, {Julia ML} and Karen CANFELL and Joan Cunningham and Gail Garvey and Suzanne Moore and O'Connell, {Dianne L.} and Patricia Valery and John Condon",
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Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016. / Li, Ming; Roder, David; Whop, Lisa; Diaz, Abbey; Baade, Peter D.; Brotherton, Julia ML ; CANFELL, Karen; Cunningham, Joan; Garvey, Gail; Moore, Suzanne; O'Connell, Dianne L.; Valery, Patricia; Condon, John.

In: Journal of Medical Screening, 12.11.2018, p. 1-9.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016

AU - Li,Ming

AU - Roder,David

AU - Whop,Lisa

AU - Diaz,Abbey

AU - Baade,Peter D.

AU - Brotherton,Julia ML

AU - CANFELL,Karen

AU - Cunningham,Joan

AU - Garvey,Gail

AU - Moore,Suzanne

AU - O'Connell,Dianne L.

AU - Valery,Patricia

AU - Condon,John

PY - 2018/11/12

Y1 - 2018/11/12

N2 - Objective: Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. Methods: Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. Results: Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher. Conclusions: Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.

AB - Objective: Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. Methods: Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. Results: Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher. Conclusions: Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.

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DO - 10.1177/0969141318810719

M3 - Article

SP - 1

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JO - Journal of Medical Screening

T2 - Journal of Medical Screening

JF - Journal of Medical Screening

SN - 0969-1413

ER -