title: The diagnostic process of cervical cancer; areas of good practice, and windows of opportunity.
abstract: OBJECTIVE
  Despite an extensive screening programme in The Netherlands, some cases of cervical cancer are still diagnosed in late stages of disease. The aim of the present study was to investigate which elements in the diagnostic process of cervical cancer may be improved.
  
  
  METHODS
  This is a retrospective study of 120 patients with cervical cancer diagnosed between January 1st 2008 and June 1st 2010 at the University Medical Center Utrecht. Patient charts, referral information, and pathology results were analyzed.
  
  
  RESULTS
  39.1% of cancer cases were screen or interval detected; the other 60.9% of patients had not been screened, either due to non-attendance or because they fell outside the age range for screening. The final diagnosis of cervical cancer was established by biopsy in 77 (64.2%) and by excision of the cervical transformation zone in 35 (29.2%) of the patients. Fifteen (43%) of these excisions could have been avoided if biopsies would have been taken at the first examination, and had shown invasive cancer.
  
  
  CONCLUSIONS
  Cervical cancer screening aims at early detection of precursor lesions to decrease the incidence of cancer. This in-depth analysis suggests that improvement of quality of care is to be expected from correct recognition of cervical cancer by physicians and adjustments of the screening programme to reach younger women and non-responders.
authors.affiliation: University Medical Center Utrecht, UMC Cancer Center, Department of Gynaecological Oncology, P.O. box 85500, Utrecht, 3508 GA, The Netherlands. Electronic address: a.zaal@umcutrecht.nl.
authors.forename: Afra
authors.initials: A
authors.lastname: Zaal
authors.affiliation: University Medical Center Utrecht, UMC Cancer Center, Department of Gynaecological Oncology, P.O. box 85500, Utrecht, 3508 GA, The Netherlands.
authors.forename: Marlieke A
authors.initials: MA
authors.lastname: de Wilde
authors.affiliation: Meander Medical Center, Department of Gynaecology, Amersfoort, The Netherlands.
authors.forename: M Jitze
authors.initials: MJ
authors.lastname: Duk
authors.affiliation: Antonius Medical Center, Department of Gynaecology, Nieuwegein, The Netherlands.
authors.forename: G C
authors.initials: GC
authors.lastname: Graziosi
authors.affiliation: Diakonessenhuis, Department of Gynaecology, Utrecht, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Haaften
authors.affiliation: Center Gynaecological Oncology Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: von Mensdorff-Pouilly
authors.affiliation: University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Diest
authors.affiliation: University Medical Center Utrecht, UMC Cancer Center, Department of Gynaecological Oncology, P.O. box 85500, Utrecht, 3508 GA, The Netherlands.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Zweemer
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: University Medical Center Utrecht, UMC Cancer Center, Department of Gynaecological Oncology, P.O. box 85500, Utrecht, 3508 GA, The Netherlands.
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000166:cytology / Q000473:pathology; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D019092:Conization / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology
keywords: Cervical cancer; Colposcopy; Diagnosis; Quality of care; Screening; Uterine cervix