title: Differences in screening history, tumour characteristics and survival between women with screen-detected versus not screen-detected cervical cancer in the east of The Netherlands, 1992-2001.
abstract: OBJECTIVE
  In The Netherlands, despite a national screening programme since 1996, invasive cervical cancers have been detected in screened and non-screened women. The aim of this study was to determine differences between Pap-smear history, tumour characteristics and survival of patients with a tumour detected by the screening programme (SP) or outside the screening programme (OSP) in the region of the Comprehensive Cancer Centre Stedendriehoek Twente in the period 1992-2001.
  
  
  METHODS
  In this period, 263 cervical cancer cases in women aged 30-60 were selected from the regional cancer registry. Patient and tumour characteristics, treatment and follow-up data were extracted. Also, detection modality of the tumour and Pap score of the smear which led to the diagnosis ('diagnostic smear') and the 'previous smear' were registered.
  
  
  RESULTS
  Thirty-five percent were SP tumours and 65% were OSP tumours. SP tumours had a lower stage (FIGO I) than OSP tumours: 84% versus 57%. The OSP group exhibited a twofold increase in risk of death (p<0.05) compared to the SP group. Subsequently 61 women (23%) and 46 (17%) women had an abnormal Pap smear (Pap II or higher) 5 and 3 years before the 'diagnostic smear', respectively. Furthermore, 37 women (14%) and 23 women (9%) had a normal smear 5 and 3 years before diagnosis, respectively.
  
  
  CONCLUSIONS
  SP tumours have a lower stage and a better prognosis, probably due to the fact that the screening programme detects the slow growing tumours which in general have a better prognosis. Furthermore, detection and treatment of patients with suspicious smears have been suboptimal and attention should therefore be paid to prompt follow-up of suspicious smears.
authors: Comprehensive Cancer Centre Stedendriehoek Twente, Hoedemakerplein 2, 7511 JP Enschede, The Netherlands. m.vd.aa@ikst.nl
authors: Maaike A
authors: MA
authors: van der Aa
authors: Eltjo M J
authors: EM
authors: Schutter
authors: Monika
authors: M
authors: Looijen-Salamon
authors: Jolise E
authors: JE
authors: Martens
authors: Sabine
authors: S
authors: Siesling
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000367:Age Factors; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D065006:Papanicolaou Test; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D014626:Vaginal Smears