Does delaying the onset of pap smear screening in Newfoundland (NL) impact on cervical cancer rates?
Bibliographic record
Abstract
e12002 Background: Cervical cancer (CC) rates have declined with the advent of pap smear screening. In most organized programs, screening starts by 18 to 25 years of age. The 2009 American College of Obstetrics and Gynecology guidelines increased the age of first screening to 21 years regardless of the onset of sexual activity. NL is known for the highest CC incidence and mortality rates in Canada. Until 2001, NL has offered screening opportunistically. Since then, all women have been offered screening within 3 yrs of sexual intercourse or by the age of 18. Methods: All cases of invasive CC affecting women up to 29 years were identified from the NL Cancer Registry from 1992 – 2008. Age at diagnosis, gravidity, smoking, disease stage, histology, screening history and outcome data were collected. The total number of pap smears in the under 25 year old (yo) demographic and corresponding abnormalities requiring follow up were reviewed. Results: From 1992 – 2008, 37 women aged 19 to 29 had invasive CC. The incidence ranged from 0 to 10.81 per 100,000 women/yr under 25 yo, and from 0 to 32.3 per 100,000 women/yr aged 25-29. Two women aged 19 and 21 had invasive CC, both stage 1B1 and both presenting with symptoms. No woman under 21 had CC since 1995. For the 22 to 24 yo subset, 7 women had invasive CC: 5 stage 1A, 4 stage1B1, and 1 stage 4a. None died of their disease. In the 25-29 yo subset: 15 were stage 1A, 11 1B, 4 2B, and 1 3B. 3 women aged 26 to 28 died from their cancer presenting with stages 1B2 to 2B. From 1992 – 2008, from 1744/100 000 women to 4591/100 000 women under 25 had abnormal pap smears requiring further follow up and intervention. Since 2001, no invasive cancer was diagnosed in a woman under 25. Various models were constructed, none of which showed any significant difference in incidence and mortality between the younger and older groups, the use of organized screening or other variables. Conclusions: Increasing the age of first pap smear to 21 or 25 in NL will decrease the number of pap smears and corresponding followup and treatment for abnormal smears without significantly impacting on incidence or mortality of invasive cervical cancer. Delaying the start of screening may therefore spare the deleterious effects of over treatment and anxiety in younger women. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".