Kathleen A. Kearney

Advancing age and cervical cancer screening and prognosis

To determine associations between advancing age and screening behavior and prognosis in long‐term members of a prepaid health plan diagnosed with invasive cervical cancer (ICC).

Immune function declines with unemployment and recovers after stressor termination.

Objective: To examine the effect of unemployment on natural killer cell cytotoxicity (NKCC) and, in a subsample of persons who become re-employed, to determine if, after termination of the stressor, immune values recover to levels similar to matched controls. Methods: One hundred unemployed and 100 matched employed healthy men and women, aged 29 to 45 years, were followed for 4 months with monthly blood samples taken to measure NKCC, the ability of NK cells to kill target cells. Twenty-five participants obtained employment before the end of the study, leaving 75 unemployed (and 75 employed) participants in the main sample. For unemployed participants who obtained employment before the end of the study, subsample analyses compared NKCC levels before and after obtaining a new job. Results: The persistently unemployed sample had significantly lower NKCC levels for all three effector:target ratios (100:1, p = .0004; 50:1, p = .002; and 25:1, p = .02) when compared with the matched employed sample. There were no significant gender effects. In the subsample analyses, NKCC was significantly higher after the participants became employed, compared with their unemployed period, with substantial “recovery” of immune function (44%–72%) compared with values from the steadily employed group. Conclusions: Chronic stress is associated with persistent NKCC impairment. When the chronic stressor is terminated, however, the immune cell functional capacity quickly begins to recover. We believe this is the first study in humans to document immune function recovery after the definable end of a chronic stressor. NK = natural killer; NKCC = natural killer cell cytotoxicity.

Using self-generated identification codes to match questionnaires in panel studies of adolescent substance use.

The usefulness of self-generated codes for anonymously linking data in panel studies of adolescent substance use was investigated in a study of Irish post-primary students and sample bias resulting from this procedure considered. A seven element code exactly matched 71% of questionnaires over one month when school absences were taken into account. Allowing codes to differ on one element to compensate for respondent errors increased matching success to 88% without resulting in appreciable mismatching. Unmatched compared with exactly matched respondents tended to be male, lower SES, have more spending money, and were less closely bonded to school and religion. They also were more involved in smoking, drinking, and drug use and had more favorable beliefs toward these behaviors. Off-one respondents generally were intermediate on these measures. However, the differences were small and the characteristics of the combined matched respondents closely resembled those of the total sample. When predicting substance use, the regression coefficients were quite similar for the matched and unmatched groups and the total sample. The data thus provide evidence for the usefulness of self-generated codes in panel and longitudinal studies of adolescents when anonymity and confidentiality are of concern.

Stage at diagnosis and mortality in patients with adenocarcinoma and adenosquamous carcinoma of the uterine cervix diagnosed as a consequence of cytologic screening

OBJECTIVE To determine if cytologic screening is associated with early stage at diagnosis of and decreased mortality from invasive adenocarcinoma and adenosquamous carcinoma of the uterine cervix. STUDY DESIGN We retrospectively reviewed the medical records of all 169 women diagnosed with invasive adenocarcinoma or adenosquamous carcinoma of the cervix in a prepaid health plan during 1988-1994. Differences in stage and survival were assessed in relation to screening history and symptoms. RESULTS Among the 169 cases, late-stage disease was present in 19/169 women (11.2%) at the time of diagnosis, and 24/269 (14.2%) women died of the disease during the three-year follow-up period. Women whose cancer was screen detected numbered 48/169 (28.4%) and were less likely to present with late-stage disease than non-screen-detected women: 2/48 (4.2%) versus 17/121 (14.0%) (P = .05). A mortality advantage at three years from diagnosis was associated with screen-detected cancers: 1/48 (2.1%) versus 23/121 (19.0%) (P = .002), and this advantage persisted after controlling for stage at diagnosis. CONCLUSION Invasive adenocarcinomas and adenosquamous carcinomas of the cervix detected by screening are found at an earlier stage and are associated with lower disease-specific mortality than those not detected by screening.

Cervical cancer after multiple negative cytologic tests in long-term members of a prepaid health plan

OBJECTIVE To estimate squamous cell cervical cancer incidence within 3.5 years of 1, 2 and > or = 3 consecutive, normal cytologic tests. STUDY DESIGN Data were from a case-control study of cervical cancer screening efficacy. Long-term members of a prepaid health plan diagnosed with cancer from 1983 to 1995 (the cases) were grouped by number of prior conventional cytologic tests and by time from the last negative screening test to the diagnosis date. Women from the population at risk were estimated by multiplying the timated by multiplying the proportions of women without cancer (the matched controls) in each screening category by the numbers of long-term of the numbers of long-term female members enrolled from male members enrolled from 1983 to 1995. RESULTS Of an estimated 6,802,641 woman-years of observation, 129 cases were diagnosed within 3.5 years of > or = 21 negative screening test. After > or = 3 consecutive negative tests, incidence per 100,000 woman-years grouped by time from the last negative screening test were: 1.43 (26/1,813,552) 0-18 months later, 4.24 (17/400,584) 19-30 months later and 4.73 (10/211,217) 31- 42 months later. CONCLUSION The first 18 months after the last negative screening Pap test in women with > or = 3 prior negative tests, cancer incidence increases to an estimated 4-5 per 100,000 woman-years in each of the subsequent 2 years.

Risk of invasive squamous carcinoma of the cervix associated with screening intervals of 1, 2, and 3 years: a case–control study

Abstract Objective: To compare the risks of developing invasive squamous carcinoma of the cervix (ISCC) associated with different lengths of time following a negative Pap test result. Methods: We conducted a matched case–control study using subjects who were members of Kaiser Permanente Medical Care Plan–Northern California Region. Women with an initial diagnosis of ISCC between 1983 and 1995 who had been members of the Health Plan at least 30/36 months before the date of histologic diagnosis comprised the cases (n = 482). Two controls per case (when available) were matched for age, length of membership, and race (n = 934). We defined the screening interval as the time between the last negative Pap test result and the histologic diagnosis of invasive malignancy. We defined a negative Pap test result as a result reported as normal or one with a reading not associated with squamous dysplasia or cancer (eg, benign cellular changes, metaplasia). Results: Invasive squamous carcinoma of the cervix was diagnosed in 103, 42, and 28 women at 0–18-, 19–30-, and 31–42-month intervals (respectively) following a negative test result. The odds ratio for 2- versus 1-year intervals was 1.72 (95% CI, 1.12–2.64; P = 0.013), and for 3- versus 1-year intervals was 2.06 (95% CI, 1.21 –3.50; P = 0.007). The odds ratio for 3- versus 2-year intervals was 1.20 (95% CI, 0.65–2.21; P = 0.561). These results were not substantially changed by controlling for the number of previous consecutive negative test results or for ever having had an abnormal test result while a plan member. Conclusions: In this large health plan, the odds ratios for the diagnosis of ISCC following a negative Pap test result were significantly greater for 2- and 3-year intervals than for a 1-year interval. We were unable to demonstrate a significant difference between 3- and 2-year intervals. The relevance of our findings needs to be placed in the context of the low absolute risks of developing ISCC during the first 3 years following a negative Pap test result before making policy recommendations.

Cervical Cancer After Multiple Negative Cytologic Tests in Long-Term Members of a Prepaid Health Plantle-group

OBJECTIVE To estimate squamous cell cervical cancer incidence within 3.5 years of 1, 2 and > or = 3 consecutive, normal cytologic tests. STUDY DESIGN Data were from a case-control study of cervical cancer screening efficacy. Long-term members of a prepaid health plan diagnosed with cancer from 1983 to 1995 (the cases) were grouped by number of prior conventional cytologic tests and by time from the last negative screening test to the diagnosis date. Women from the population at risk were estimated by multiplying the timated by multiplying the proportions of women without cancer (the matched controls) in each screening category by the numbers of long-term of the numbers of long-term female members enrolled from male members enrolled from 1983 to 1995. RESULTS Of an estimated 6,802,641 woman-years of observation, 129 cases were diagnosed within 3.5 years of > or = 21 negative screening test. After > or = 3 consecutive negative tests, incidence per 100,000 woman-years grouped by time from the last negative screening test were: 1.43 (26/1,813,552) 0-18 months later, 4.24 (17/400,584) 19-30 months later and 4.73 (10/211,217) 31- 42 months later. CONCLUSION The first 18 months after the last negative screening Pap test in women with > or = 3 prior negative tests, cancer incidence increases to an estimated 4-5 per 100,000 woman-years in each of the subsequent 2 years.