title: Frequency and outcome of cervical cancer prevention failures in the United States.
abstract: We measured the frequency and outcome of cervical cancer prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous cancers (1 in 187,786 Pap tests), glandular cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that cervical cancer prevention practices are remarkably successful in preventing squamous cancers, although a high frequency of failures results in low-impact negative outcomes.
authors.affiliation: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, and Western Pennsylvania Hospital 15232, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Raab
authors.forename: Dana Marie
authors.initials: DM
authors.lastname: Grzybicki
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Zarbo
authors.forename: Chris
authors.initials: C
authors.lastname: Jensen
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Geyer
authors.forename: Janine E
authors.initials: JE
authors.lastname: Janosky
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Meier
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Vrbin
authors.forename: Gloria
authors.initials: G
authors.lastname: Carter
authors.forename: Kim R
authors.initials: KR
authors.lastname: Geisinger
mesh_terms: D003127:Colposcopy / Q000592:standards / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D010346:Patient Care Management / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000592:standards / Q000706:statistics & numerical data*