The pattern of attendance at general practice in the years before the diagnosis of cervical cancer. A case control study

The study concerned a nation-wide Danish investigation of 519 women who received the diagnosis of cancer of the cervix uteri in 1983. Data on doctor-contact patterns during the single year, and for the 3 years pre-diagnosis were obtained on 428 of the women (82%), and a comparison was made with an age- and practice-matched control group. Significantly more patients than controls had had no doctor contact, and their odds rate for cancer development was higher than that of the patients who had had at least one contact with their general practitioner during the previous one or three years. Those patients with more advanced stages of cancer, those who had never had a cytological examination, and those living in counties without organized screening programmes were in general the ones with fewest doctor-contacts, and the odds rates for cancer development among the no-contact patients were highest in these groups. No doctor-contact was more common among patients living in counties without organized screening programmes, and these women represented a relatively higher risk group than those living in counties with organized screening. More women are thus caught in the organized screening net, compared with unsystematized screening. The findings support systematic rather than opportunistic unsystematic screening for cancer of the cervix.