Am J Prev Med 1993 May-Jun;9(3):133-8
Breast and cervical cancer screening of poor, elderly, black women:
clinical results and implications. Harlem Study Team.
Mandelblatt J, Traxler M, Lakin P, Kanetsky P, Thomas L, Chauhan P, Matseoane
S, Ramsey E.
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering
Cancer Center, New York, NY 10021.
Our objective is to describe the clinical findings from a nurse-practitioner-based
breast and cervical cancer screening program for poor, elderly, black
women. We designed a cross-sectional descriptive study set at an urban
public hospital medical clinic. All women 65 years of age and older were
eligible to be screened. We measured these main outcomes: rates of participation,
abnormal tests, and neoplasia. Women were offered screening during a routine
visit. Of 689 women, 491 (71%) participated. Mammography was completed
by 66% of women; one had stage 1 cancer, and 76% were negative. Among
the women (24%) with abnormal mammograms, the overwhelming majority were
diagnosed with benign lesions. For ten of 450 women completing Papanicolaou
(Pap) smears, results were suspicious or positive for malignancy, for
a prevalence rate of 22.2/1,000 (95% confidence interval [CI] = 8.6/1,000
to 35.8/1,000). Three were subsequently designated falsely positive; five
had confirmed cervical neoplasia; and two had other reproductive malignancies.
Two women with negative smears also had neoplasia: one with vulvar cancer
and one with human papilloma virus (HPV) infection and cervical neoplasia,
for a total of six cervical neoplasias. Interestingly, one-fifth of women
with a hysterectomy had an intact cervix, including one with cervical
neoplasia. Nearly one-third of women with abnormal Paps or mammograms
failed to complete follow-up. Success of screening programs for the elderly
will depend on the risk group targeted, careful examination, degree of
sensitivity and specificity of the tests, and acceptability of follow-up
diagnosis and treatment.
PMID: 8347363 [PubMed - indexed for MEDLINE]
