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In the United States, population-level CIN2+ declines that are attributable to vaccination are more challenging to measure because of a lack of national screening registries and because CIN2+ diagnosis is affected by changes in screening recommendations that have been implemented since vaccine introduction.
Our estimates will be less likely to be affected by changes in screening strategies.
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However, interpretation of these trends is confounded by changes in US demographics and changes in screening criteria over the past decade.
Here we aim to describe the characteristics of women who develop cervical cancer in their twenties in terms of stage at diagnosis, histology, treatment and socioeconomic status, and to examine changes in screening history by stage.
In the majority of countries screening was implemented by May 1, 2009 although we were unable to determine whether there were any substantial changes in screening protocols after commencement of screening but before confirmation of the first local case.
Although these problems were at least partly remediable by changes in the screening protocol, they serve to remind us that the practical screening of large numbers of patients with limited resources is inevitably an imperfect process.
This change in screening precisely at the guideline recommended ages would imply that colorectal cancer screening use at the recommended age threshold increased by 100%.
The cause of this improvement is hard to determine, but could not be accounted for by changes in referral patterns, screening or case-mix in the multivariate analysis.
The results suggest that 35% of the observed mortality decline can be explained by changes in risk factors, 53% by screening and 12% by improvement in treatment [ 19].
Changes in cancer incidence trends in general are affected not only by screening patterns but also by changes in cancer risk factors and population demographics.
The mortality reduction is therefore more likely to be explained by changes in risk factors and by improved treatment than by screening mammography.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com