title: Process of care failures in invasive cervical cancer: systematic review and meta-analysis.
abstract: OBJECTIVE
  As invasive cervical cancer is preventable when screening and treatment of pre-invasive lesions are timely and appropriate, several past studies attempted to enumerate the quality of preventive care invasive cervical cancer subjects received before diagnosis. Objectives of the present study were to review and to summarize the findings of these studies in a meta-analysis.
  
  
  METHODS
  Data from 42 studies were used to estimate DerSimonian and Laird random effects models for the various failures in care along the cancer care continuum. Analyses were also conducted within strata characterized by variables deemed to account for heterogeneity in meta-regression analyses.
  
  
  RESULTS
  Poor Pap screening frequency was the primary factor attributable to development of invasive cervical cancer. On average, 53.8% (95% confidence interval: 43.6-66.3) of invasive cervical cancer subjects had inadequate screening histories and 41.5% (95% confidence interval: 35.4-48.7) were never screened. There was significant temporal improvement in the proportion of women screened at least once over a lifetime but not in the proportion with overall deficient histories. An estimated 29.3% (95% confidence interval: 21.2-40.4) of failures to prevent invasive cervical cancer can be attributed to false-negative Pap smears and 11.9% (95% confidence interval: 9.0-15.6) to poor follow-up of abnormal results.
  
  
  CONCLUSIONS
  Appropriate assessment of the effect of combined failures in the process of care must be done in comprehensive audit studies.
authors.affiliation: Department of Oncology and Epidemiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.forename: Patricia
authors.initials: P
authors.lastname: Goggin
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D009361:Neoplasm Invasiveness / Q000517:prevention & control*; D011787:Quality of Health Care; D011792:Quebec; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control