title: Cervical cancer still presents symptomatically 20 years after the introduction of a structured national screening programme.
abstract: OBJECTIVE
  To investigate the pattern of presentation of cervical cancer and to identify the characteristics of women who present symptomatically with cervical cancer.
  
  
  METHODS
  A retrospective study of all cervical cancer cases diagnosed over a 4-year period. Details of mode of presentation, stage at diagnosis and cytological/gynaecological history were collated.
  
  
  RESULTS
  In total, 148 cases were identified with a median age of 46 years (range, 20-91 years). In this population, 112 (75.7%) women were within the screening age range. Forty-eight (33.6%) were asymptomatic at diagnosis and presented through the colposcopy clinic. All asymptomatic women (100%) had stage I disease at diagnosis, compared with 37.2% of the symptomatic group (P < 0.001). Postmenopausal bleeding was the most common presenting symptom (33%), followed by postcoital bleeding (14.2%), intermenstrual bleeding (12.2%) and increased vaginal discharge (3.4%). The majority of symptomatic women presented through colposcopy, gynaecological oncology or gynaecology clinics (87.6%); however, 6.5% presented through the emergency department. Women who presented symptomatically were significantly older than asymptomatic women (54.9 versus 38.1 years, P < 0.001). Women at risk of social isolation (non-English speakers, alcohol abusers, heavy smokers, receiving treatment for psychiatric disease) were more likely to present with symptoms, through the emergency department and with advanced disease at diagnosis (stage II+) (P < 0.001).
  
  
  CONCLUSIONS
  A review of local cervical cancer cases can highlight areas of weakness in a screening programme and can identify populations who are at risk in presenting symptomatically with advanced disease.
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Myriokefalitaki
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Potdar
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: L
authors.initials: L
authors.lastname: Barnfield
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: Q
authors.initials: Q
authors.lastname: Davies
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Moss
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003127:Colposcopy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D011247:Pregnancy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology
keywords: cervical cancer; emergency presentation; postmenopausal bleeding; screening; symptoms