title: The screening histories of women with invasive cervical cancer, Connecticut.
abstract: 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.
authors.affiliation: Department of Medicine, University of Utah School of Medicine, Salt Lake City 84132, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Janerich
authors.forename: O
authors.initials: O
authors.lastname: Hadjimichael
authors.forename: P E
authors.initials: PE
authors.lastname: Schwartz
authors.forename: D M
authors.initials: DM
authors.lastname: Lowell
authors.forename: J W
authors.initials: JW
authors.lastname: Meigs
authors.forename: M J
authors.initials: MJ
authors.lastname: Merino
authors.forename: J T
authors.initials: JT
authors.lastname: Flannery
authors.forename: A P
authors.initials: AP
authors.lastname: Polednak
mesh_terms: 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