Estimation of the duration of the preclinical phase of cervical adenocarcinoma suggests that there is ample opportunity for screening.
OBJECTIVE
The purpose of this study was to determine the mean time for progression from cervical adenocarcinoma in situ (ACIS) to invasive cervical adenocarcinoma in order to assess the feasibility of screening and secondary prevention.


METHODS
To approximate time to progression from in situ to invasive lesions, we calculated and compared mean ages at diagnosis of ACIS and invasive adenocarcinoma from patients registered in the SEER (NCI's Surveillance, Epidemiology, and End Results) public-use database from 1973 to 1995 [1]. Findings are contrasted with means calculated from patients with squamous lesions registered during the same period. Statistical significance was tested with the t test for independent samples.


RESULTS
The database includes 5845 patients with glandular lesions; 1476 (25%) have ACIS and 4369 (75%) have invasive adenocarcinoma. There are 143,333 women with squamous lesions; 120,317 (84%) have squamous CIS and 23,016 (16%) have invasive squamous cancers. Mean age (std error) at diagnosis is 38.8 (0.3) years for ACIS and 51.7 (0.3) years for invasive adenocarcinoma; the mean difference is 13.0 (0.5) years. Mean age (std error) for squamous CIS is 33.6 (0.0) and for invasive squamous cancer is 51.4 (0.1); mean difference is 17.9 (0.1).


CONCLUSIONS
While not quite as long as for squamous lesions, the average of 13 years that elapses during progression from cervical ACIS to invasive adenocarcinoma allows ample time for screening for the preinvasive lesion and for secondary prevention of invasive cervical adenocarcinoma. The similar mean ages at diagnosis suggest that women who will develop cervical adenocarcinoma should be as amenable and accessible to screening programs as are those with squamous lesions.
Plaxe
S C
SC
Department of Reproductive Medicine, Department of Pathology, University of California at San Diego, 402 Dickinson Street, San Diego, California, 92103, USA.
Saltzstein
S L
SL
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*