title: Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review.
abstract: BACKGROUND
  Cervical cancer in young women presents a diagnostic challenge because gynaecological symptoms are common but underlying disease is rare.
  
  
  OBJECTIVE
  To explore the potential for using cytology as a diagnostic aid for cervical cancer in young women.
  
  
  METHODS
  Retrospective review of primary care records and cytology data from the national cervical screening database and national audit of cervical cancers.
  
  
  METHODS
  Four datasets of women aged 20-29 years in England were examined: primary care records and national screening data from an in-depth study of cervical cancers; cytology from the national audit of cervical cancers; whole-population cytology from the national screening database; and general-population primary care records from the Clinical Practice Research Datalink. The authors explored the sensitivity and positive predictive value (PPV) of symptomatic cytology (earliest <12 months before diagnosis) to cervical cancer.
  
  
  RESULTS
  The estimated prevalence of cervical cancer among symptomatic women was between 0.4% and 0.9%. The sensitivity of moderate dyskaryosis (high-grade squamous intraepithelial lesion [HSIL]) or worse in women aged 20-29 years was 90.9% to 96.2% across datasets, regardless of symptom status. The PPV was estimated to be between 10.0% and 30.0%. For women aged 20-24 years, the PPV of '?invasive squamous carcinoma' was 25.4%, and 2.0% for severe or worse cytology.
  
  
  CONCLUSIONS
  Cytology has value beyond screening, and could be used as a diagnostic aid for earlier detection of cervical cancer in young women with gynaecological symptoms by ruling in urgent referral.
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London.
authors: Anita Ww
authors: AW
authors: Lim
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London.
authors: Rebecca
authors: R
authors: Landy
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London.
authors: Alejandra
authors: A
authors: Castanon
authors: Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London.
authors: Antony
authors: A
authors: Hollingworth
authors: Department of Primary Care, St Luke's Campus, University of Exeter, Exeter.
authors: Willie
authors: W
authors: Hamilton
authors: East Pennine Cytology Training Centre, Raynham House, Leeds.
authors: Nick
authors: N
authors: Dudding
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London.
authors: Peter
authors: P
authors: Sasieni
mesh_terms: D000328:Adult; D003584:Cytological Techniques / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D004739:England; D005260:Female; D006801:Humans; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology*
keywords: cervical cancer; cervical cytology; early diagnosis; gynaecological symptoms; retrospective study; young women