The European Journal of Public Health Advance Access published online on May 4, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm043
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Invasive Cervical Cancer: a failure of screening
Jacqueline Spayne1,3, Ida Ackerman1,3, Michael Milosevic2,3, Allan Seidenfeld4, Alan Covens5 and Lawrence Paszat1,6,7
1 Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
2 Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada
3 Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
4 Department of Medical Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
5 Department of Gynecological Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
6 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
7 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Correspondence:Dr Ida Ackerman, Department of Radiation Oncology, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada, tel: (416) 480-5329, fax: (416) 480-6002, e-mail: ida.ackerman{at}sunnybrook.ca
Received September 13, 2006 , accepted March 28, 2007
Background: Cervical screening is an effective prevention measure. It is unclear whether cervical cancer results from non-participation in screening or from failures in detection by screening. Analysis of the screening history of patients with cervix cancer may contribute to understanding failures in prevention. Methods: A cohort of patients presenting during 1 year was identified. Dates and results of cervical smears in the 4 years prior to presentation were extracted from a screening database. Patients were grouped as follows: ‘No screening’—no Pap records; ‘Pre-diagnostic’—one or more Pap tests within 6 months of presentation; ‘Sporadic screening’—one Pap test between 6 and 48 months prior to presentation; and ‘Regular screening’—at least two Pap tests 6–48 months before presentation. Results: 225 patients were identified (median age: 48 years, range 25–107). Eighty- eight had no records of screening; a further 66 were categorized as pre-diagnostic. These two groups (68% of incident cases) were considered not to have participated in routine screening. A further 15% had sporadic screening tests, but only 37 patients (16%) had evidence of regular screening. Clinically, 53, 41 and 6% presented with early, locally advanced and metastatic disease, respectively. Older patients (>50 years) were more likely to present with advanced disease (61 vs 37% at least Stage II). Conclusions: These results suggest that the failure to prevent invasive cervix cancer in this population can largely be attributed to failures in recruitment for screening.
Keywords: cervical intraepithelial neoplasia, cervix cancer, papanicolaou test.