Invasive cervical cancer: a failure of screening.
BACKGROUND
Cervical screening is an effective prevention measure. It is unclear whether cervical cancer results from non-participation in screening or from failures in detection by screening. Analysis of the screening history of patients with cervix cancer may contribute to understanding failures in prevention.


METHODS
A cohort of patients presenting during 1 year was identified. Dates and results of cervical smears in the 4 years prior to presentation were extracted from a screening database. Patients were grouped as follows: 'No screening'--no Pap records; 'Pre-diagnostic'--one or more Pap tests within 6 months of presentation; 'Sporadic screening'--one Pap test between 6 and 48 months prior to presentation; and 'Regular screening'--at least two Pap tests 6-48 months before presentation.


RESULTS
225 patients were identified (median age: 48 years, range 25-107). Eighty- eight had no records of screening; a further 66 were categorized as pre-diagnostic. These two groups (68% of incident cases) were considered not to have participated in routine screening. A further 15% had sporadic screening tests, but only 37 patients (16%) had evidence of regular screening. Clinically, 53, 41 and 6% presented with early, locally advanced and metastatic disease, respectively. Older patients (>50 years) were more likely to present with advanced disease (61 vs 37% at least Stage II).


CONCLUSIONS
These results suggest that the failure to prevent invasive cervix cancer in this population can largely be attributed to failures in recruitment for screening.
Spayne
Jacqueline
J
Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON, Canada.
Ackerman
Ida
I
Milosevic
Michael
M
Seidenfeld
Allan
A
Covens
Alan
A
Paszat
Lawrence
L
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*