"Rapid-Onset" Cervical Cancer due to Failures in a Screening Program

Cervical cancer is considered a preventable disease because, in its preinvasive form, it can be detected by a Papanicolaou (Pap) smear and effectively eradicated by local therapy. The fact that new cases of invasive cancers are reported even in "well-organized" screening programs has been blamed on the so-called rapid-onset cancers. This assumption led to resistance in the medical community to accept a 3-year interval between Pap smear tests. Rapid-onset cervical cancer has been defined as cancer diagnosed within 3 years of a normal Pap smear. Because nearly 30% of patients in whom cervical cancer is diagnosed never had a Pap smear and another 30% did not follow the recommendation to be tested at least every 3 years, we could theorize that the other 40%, who had a normal-appearing cytological workup in the last 3 years, have a rapidly occurring cancer. However, a review of the reasons for screening failure in those patients reveals that inadequate and false-negative smears and failure to investigate an abnormal test account for more than 95% of so-called rapid-onset cervical cancers. Therefore, if eradication of cervical cancer is to be accomplished in the twenty-first century, countries will have to develop an organized comprehensive screening program that includes (1) recruitment planning to extend screening to all eligible women, (2) a recall system for investigation and management of abnormalities, (3) quality assurance for cytology and colposcopy, and (4) quality control of the program.