Invasive cervical cancer: a failure of screening

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.

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.

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).

These results suggest that the failure to prevent invasive cervix cancer in this population can largely be attributed to failures in recruitment for screening.