title: Stage at diagnosis and mortality in patients with adenocarcinoma and adenosquamous carcinoma of the uterine cervix diagnosed as a consequence of cytologic screening.
abstract: OBJECTIVE
  To determine if cytologic screening is associated with early stage at diagnosis of and decreased mortality from invasive adenocarcinoma and adenosquamous carcinoma of the uterine cervix.
  
  
  METHODS
  We retrospectively reviewed the medical records of all 169 women diagnosed with invasive adenocarcinoma or adenosquamous carcinoma of the cervix in a prepaid health plan during 1988-1994. Differences in stage and survival were assessed in relation to screening history and symptoms.
  
  
  RESULTS
  Among the 169 cases, late-stage disease was present in 19/169 women (11.2%) at the time of diagnosis, and 24/269 (14.2%) women died of the disease during the three-year follow-up period. Women whose cancer was screen detected numbered 48/169 (28.4%) and were less likely to present with late-stage disease than non-screen-detected women: 2/48 (4.2%) versus 17/121 (14.0%) (P = .05). A mortality advantage at three years from diagnosis was associated with screen-detected cancers: 1/48 (2.1%) versus 23/121 (19.0%) (P = .002), and this advantage persisted after controlling for stage at diagnosis.
  
  
  CONCLUSIONS
  Invasive adenocarcinomas and adenosquamous carcinomas of the cervix detected by screening are found at an earlier stage and are associated with lower disease-specific mortality than those not detected by screening.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Department of Quality and Utilization, and Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
authors.forename: Hai-Yen
authors.initials: HY
authors.lastname: Sung
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kearney
authors.forename: Marie
authors.initials: M
authors.lastname: Miller
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hiatt
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology*; D018196:Carcinoma, Adenosquamous / Q000401:mortality* / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology*; D014626:Vaginal Smears / Q000706:statistics & numerical data