The screening histories of women with invasive cervical cancer, Connecticut.
OBJECTIVE
Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive.


METHODS
All cases of invasive cervical cancer diagnosed in a 5-year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664).


RESULTS
Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty-seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test.


CONCLUSIONS
Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow-up, make increased efforts to reach older women, and improve quality control of Pap smear readings.
Janerich
D T
DT
Department of Medicine, University of Utah School of Medicine, Salt Lake City 84132, USA.
Hadjimichael
O
O
Schwartz
P E
PE
Lowell
D M
DM
Meigs
J W
JW
Merino
M J
MJ
Flannery
J T
JT
Polednak
A P
AP
D000230:Adenocarcinoma / Q000175:diagnosis; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears