The Diagnosis of Early Carcinoma of the Cervix

Abstract

Of the malignant neoplasms occurring below the waistline, carcinoma of the cervix is the most frequent. Of 1779 carcinomata, specimens of which have been examined in the Laboratory of Obstetrics and Gynecology, University of Pennsylvania, 827 or 46.43 per cent had their origin in the cervix. In a recent review by Keene and Kimbrough (1), of 479 of our cases from 1913 to 1926, cervical carcinoma shows a five-year mortality rate of 84.76 per cent. Ward's, Healy's, Schmitz', and Heymann's figures, quoting some of the most favorable, showed a mortality rate of approximately 75 per cent. Considering the figures of this country at large, the ultimate mortality rate is probably in the neighborhood of 90 per cent. The five-year mortality rate in our early cases (Stage I, Schmitz classification) was 60.35 per cent. Even this average cannot be regarded as satisfactory, especially when it is remembered that only about 10 per cent of the cases are in this early stage when first seen, so that the real results become apparent. Dietel and Steffan-Eisen (2) found that the group made up of intelligent patients sought medical advice earlier, and consequently gave better end-results than were secured among the more ignorant classes. These observers also found that the disease was more prevalent in the latter group, due doubtless to the fact that the former class receive more skilful obstetrical treatment. The higher birth-rate among the less privileged class may also influence this finding. Dietel and Steffan-Eisen found that among all gynecologic admissions uterine carcinomata made up 6.2 per cent of ward patients and 3.9 per cent of private cases.