To determine whether women diagnosed with adenocarcinoma in situ (AIS) of the cervix are as well screened as healthy control women.
A case-control study was performed (307 cases, 1,228 controls) within a statewide registry. Cases consisted of women diagnosed with AIS on histology between 1995 and 2001. Screening histories were compiled from registry records. Variables of interest included number of previous negative Pap smears, time interval since last negative Pap smear, median time between previous negative Pap smears, proportion of negative Pap smears with an endocervical component and history of cervical abnormality.
Conditional logistic regression showed that cases and controls did not differ significantly in the number of previous negative smears or in the median time between previous negative smears. Decreasing time since last negative smear was protective against AIS, with controls more likely to have had a recent negative smear. There was no difference in the proportion of previous negative smears with an endocervical component between cases and controls; however, some complex temporal relationships were observed in the regression analysis.
Women who are diagnosed with AIS have a screening history similar to that of healthy, control women. The findings are consistent with the concept that AIS is predominantly a screening-detected disease.
"An increasing ability to detect endocervical lesions in cervical screening involves the improved diagnostic yield via use of the extended tip spatula or the cervix ( endocervical ) brush , or a combination of both as well as an understanding and recognition of AC in situ ( Mitchell et al . , 2004"
[Show abstract][Hide abstract] ABSTRACT: The objective of the present paper is to summarize and quantify the trends in incidence and mortality rates of cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) worldwide. All indexed publications, which provided information on time trends in incidence or mortality rates of cervix cancer, published during the past 12 years were included. The details of studies have been identified through searches on the MEDLINE database. Cytology screening as well as changes in socio-economic profile have led to declines in cervical SCC incidence and mortality rates worldwide. Higher percentage decline in SCC is observed in countries where organized screening programmes are available. The results suggested that Pap smear screening has played a significant role in the reduction in SCC in the US, Canada, New South Wales, and in almost all European countries (except in Ireland) as well as in some of the Asian countries. Increasing incidence and mortality rates of cervical AC has reported in many countries such as the US, Canada, UK, Iceland, Sweden, England, Spain, Finland, Slovakia, Slovenia, the Netherlands particularly among young women. However the increase was mainly in earlier periods till 1995 and stable or declining trends in cervical AC have been observed in later periods in many of the above countries such as the US, UK, Canada, Sweden. The increasing risk of AC suggested a major role for an increasing prevalence of persistent oncogenic HPV infection and its cofactors, whereas the down-turn in period effects in several countries during the 1990 s provided evidence that cytology screening is detecting more preinvasive ACs than in previous decades and suggested that screening might be starting to have a protective impact on AC. The decline in AC incidence might be due to improved specimen collection as well as due to increased awareness of AC precursors among cytopathologists and clinicians, improvements in laboratory training and quality assurance. In conclusion, cytology screening in combination with HPV screening for high-risk HPV types may maximize the possibilities of having early cervical lesions detected and treated.
Asian Pacific journal of cancer prevention: APJCP 01/2009; 10(4):645-50. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Both pre-invasive and invasive cervical glandular lesions remain outstanding challenges. Although the Australian National Cervical Screening Program has led to an accelerated decline in the incidence and mortality from squamous cervical carcinoma, this has not been observed for the subset of women who develop invasive glandular cancers. In addition, the role of cervical cytology, colposcopy and surgery in the management of women with pre-invasive glandular lesions (adenocarcinoma in situ) is far from clearly defined. In this article we have addressed three key questions for the future. Firstly, whether the Australian National Cervical Screening Program is having any impact on the incidence of cervical adenocarcinoma, and if this is the case, can we be more optimistic about the future. Secondly, whether emerging technologies ie. cervical human papillomavirus DNA testing, are likely to play an increasing role in the management of women with pre-invasive glandular lesions. Thirdly, whether there can be any expectation that human papillomavirus vaccination will impact on this disease.
[Show abstract][Hide abstract] ABSTRACT: On the basis of current evidence regarding human papillomavirus (HPV) and cancer, this chapter provides estimates of the global burden of HPV-related cancers, and the proportion that are actually "caused" by infection with HPV types, and therefore potentially preventable. We also present trends in incidence and mortality of these cancers in the past, and consider their likely future evolution.
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