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Karolinska Institute

1. Wang, Jiangrong. Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden .

Degree: 2017, Karolinska Institute

Cervical cancer incidence has substantially declined since cervical screening was implemented five decades ago. The long-term hope of eliminating cervical cancer is promising with the development of effective Human papillomavirus (HPV) vaccines. Optimising effectiveness and promoting high and equal uptake of preventive approaches are essential for achieving this goal. This thesis aimed to use register data in Sweden to perform in-depth evaluation of the effectiveness of cervical screening and investigate the factors associated with HPV vaccine uptake. The work focused in detail upon the uncertain preventive effect against cervical adenocarcinoma in relation to the finding of glandular abnormalities in screening, the effectiveness of screening for the conspicuous incidence of cervical cancer at older ages, as well as social disparity of HPV vaccine uptake in different modes of vaccination delivery. Effectiveness of cervical screening in preventing invasive cervical cancer has been reported under a case-control audit framework in Sweden, based on cervical cancer cases diagnosed in 1999-2001. Yet, assessing long-term screening history and controlling for confounding factors were hampered by unavailable data, and statistical power was limited to stratify the evaluation by histopathological type. We therefore performed an updated case-control audit based on cervical cancer cases diagnosed in 2002-2011 (Study III), to examine the risk of invasive cervical cancer in relation to screening history in the past two screening rounds, adjusted for education and stratified by the two main histopathological types. We found that non-routine participation to cervical screening was associated with increased risk of invasive cervical cancer. Having an abnormality in previous two screening rounds was associated with elevated risk, particularly if not being screened in the subsequent screening round after an abnormality. The lower effectiveness of cervical screening in preventing adenocarcinoma compared to squamous cell carcinoma resulted from both lower assurance from normal screening results, and higher risk following abnormalities. These findings reinforce the evidence of the cancer-preventive effect of cervical screening and emphasise the importance of routine participation in screening. We also identify relative weaknesses of the screening programme that would guide future research to address improvement. Atypical glandular cells (AGC) found in cervical screening is a cytological abnormality of the same type of cells giving rise to cervical adenocarcinoma. However, the long-term risk of cervical cancer following AGC has not been comprehensively investigated due to its rarity. We used the Swedish National Cervical Screening Registry (NKCx) to identify all AGC diagnosed in cervical screening from 1980-2011, examined the risk of cervical cancer by histopathological type for up to 15 years, and compared the subsequent histological assessment and risk of cancer to that after high-grade squamous intraepithelial neoplasia…

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Wang, J. (2017). Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden . (Thesis). Karolinska Institute. Retrieved from http://hdl.handle.net/10616/46113

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Wang, Jiangrong. “Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden .” 2017. Thesis, Karolinska Institute. Accessed June 18, 2018. http://hdl.handle.net/10616/46113.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Wang, Jiangrong. “Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden .” 2017. Web. 18 Jun 2018.

Vancouver:

Wang J. Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden . [Internet] [Thesis]. Karolinska Institute; 2017. [cited 2018 Jun 18]. Available from: http://hdl.handle.net/10616/46113.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Wang J. Effectiveness and equity of cervical cancer prevention : real-life evidence from organised programmes in Sweden . [Thesis]. Karolinska Institute; 2017. Available from: http://hdl.handle.net/10616/46113

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

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