The screening histories of women with invasive cervical cancer, Connecticut.

TLDR

The study aimed to determine why invasive cervical cancer cases in Connecticut were not detected earlier by reviewing screening histories. Researchers retrospectively examined all invasive cervical cancer cases diagnosed over five years in Connecticut, obtaining screening histories for 72 % of patients and using an expert panel to assess missed detection causes. Among 664 cases, 52 % had suboptimal screening, 28 % had never been screened (average age 64.5 years), and of those screened, 33 % had a Pap ≥5 years before diagnosis, 15 % lacked proper follow‑up, 10 % had misread smears, and 34 % developed cancer within three years of their last Pap, underscoring the need for timely, accurate screening and better follow‑up, especially for older women.

Abstract

OBJECTIVES. Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive. METHODS. All cases of invasive cervical cancer diagnosed in a 5-year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664). RESULTS. Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty-seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test. CONCLUSIONS. Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow-up, make increased efforts to reach older women, and improve quality control of Pap smear readings.