title: Variations in the screening history and appropriateness of management of cervical cancer in South East England.
abstract: In seven health districts in southern England, an audit of the management of cervical cancer compared with regionally developed guidelines was undertaken between 1988 and 1991. Four hundred and sixty-nine regional residents were treated in the study district hospitals. 73 (15.6%) women were appropriately staged, with increasing likelihood of appropriate staging investigations observed with higher stages (P < 0.0001) and type of hospital [Teaching 23 (21%), Non-Teaching with oncology support 11 (11.5%), Non-teaching 4 (7%), P < 0.0001] but with no change over the study period. There was no significant trend in the proportion of women treated appropriately over time, with 270 (59%) being appropriately treated, 91 (20%) under-treated and 98 (21%) over-treated overall. Appropriateness of treatment increased with higher stages (P < 0.0001) and hospital workload for cancer of the cervix (P = 0.038). Multivariable analysis indicated that survival independently and significantly decreased with age and stage, under-treatment and in cases where lymph nodes were involved or not examined. There was no change in the appropriateness of management over the 4 years, with high levels of inappropriate care. Survival was not only influenced by biological and demographic factors, but by inappropriate care.
authors: Division of Public Health Sciences, United Medical and Dental Schools of Guys and St. Thomas' Hospitals, London, U.K.
authors: C D
authors: CD
authors: Wolfe
authors: K
authors: K
authors: Tilling
authors: H M
authors: HM
authors: Bourne
authors: K S
authors: KS
authors: Raju
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D006801:Humans; D008403:Mass Screening; D008485:Medical Audit; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*