title: Performance characteristics of visualising the cervix in symptomatic young females: a review of primary care records in females with and without cervical cancer.
abstract: BACKGROUND
  The current strategy for timely detection of cervical cancer in young females centres on visualising the cervix when females present with gynaecological symptoms, but is based on expert opinion without an evidence base.
  
  
  OBJECTIVE
  To assess visualising the cervix in primary care in young females with gynaecological symptoms.
  
  
  METHODS
  A review of primary care records for females in England aged 20-29 years with cervical cancer (nationwide interview-based study) and in the general population (Clinical Practice Research Datalink database).
  
  
  METHODS
  From primary care records the proportion of females was identified with gynaecological symptoms who had documented cervical examination in the year before diagnosis (cancers) and in 1-year age bands (general population). Of these, the proportion was identified that was then referred for suspected malignancy.
  
  
  RESULTS
  Only 39% of young females with cervical cancer had documented examination at symptomatic presentation. Visualisation resulted in referral for suspected malignancy for 18% of those examined (95% confidence interval = 5% to 40%). Very few (<1.7%) symptomatic females in the general population had documented cervical examination. None were referred for suspected malignancy at the time.
  
  
  CONCLUSIONS
  The sensitivity of cervical examination to detect cancer is very low, highlighting the need for better triage tools for primary care. Until such tools are identified GPs should continue to consider cervical cancer when symptoms persist and the cervix is not obviously abnormal on clinical examination. Further research on additional triage tools such as cervical cytology used as a diagnostic aid is needed urgently.
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London.
authors: Anita Wey Wey
authors: AW
authors: Lim
authors: University of Exeter Medical School, Exeter.
authors: Willie
authors: W
authors: Hamilton
authors: Whipps Cross University Hospital, London.
authors: Antony
authors: A
authors: Hollingworth
authors: University of Exeter Medical School, Exeter.
authors: Sally
authors: S
authors: Stapley
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London.
authors: Peter
authors: P
authors: Sasieni
mesh_terms: D015746:Abdominal Pain; D002584:Cervix Uteri / Q000473:pathology*; D004414:Dyspareunia; D055088:Early Detection of Cancer / Q000379:methods*; D004739:England / Q000453:epidemiology; D055317:Evidence-Based Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D019522:Vaginal Discharge; D014626:Vaginal Smears; D055815:Young Adult
keywords: cervical cancer; early diagnosis; female; gynaecological examination; primary care; symptom assessment; young adult