Cytological early detection of cervical carcinoma: possibilities and limitations. Analysis of failures

Gynecological cytology has been intensified in the district of Schwerin since 1968. The incidence of cervical carcinoma decreased from 38.9 per 100,000 women in 1969 to 19.8 in 1991 (50% of the initial figure). The mortality decreased from 25.1 to as little as 7.0 (28% of the initial figure). Because invasive cervical carcinoma is theoretically avoidable, a total of 577 new cases observed from 1980 to 1988 were investigated in respect of participation in screening and reasons for the failures. 317 (55%) of these women did not participate in the examination more than five years before diagnosis of invasive cancer. 260 (45%) of these women were examined by gynecologists once, several times (87 (67%)) or annually (173 (33%)) during a five year period prior to the diagnosis of cancer. An independent review of the smears explained the highest number of negative smears by nonobtaining of representative material and only 19% as a ministerpretation of the cytological finding. The gynecologists failed to: take smears (36 women); carry out a cytological control or histological verification (48); obtain adequate smears (116); consider clinical symptoms (22).