Cervical cytology screening history of women diagnosed with adenocarcinoma in situ of the cervix: a case-control study

ArticleinActa cytologica 48(5):595-600 · September 2004with8 Reads
Source: PubMed
Abstract
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.
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  • [Show abstract] [Hide abstract] ABSTRACT: Since the introduction of the Pap smear screening, the incidence of squamous cell carcinoma (SCC) has decreased significantly, but the incidence of adenocarcinoma (AC) relative to SCC has increased. To compare the Pap smear history of patients with AC and SCC of the cervix. Patients for the study were identified from the database of Queensland Centre for Gynaecological Cancer. Patients with AC and SCC were matched for age at diagnosis and International Federation of Gynecology and Obstetrics stage. The final population included 188 matched pairs, being 376 patients in total. Data were collected upon the histological type of cancer, result of the most recent Pap smear, date and result of the Pap smear prior to the most recent Pap smear and symptoms. Chi-squared tests and Fisher's exact test were used to compare the two patient groups for several variables. Patients with AC had significantly more false-negative results on their most recent Pap smear (P<0.0001) than patients with SCC. The incidence of symptoms such as bleeding and/or vaginal discharge was comparable in patients with AC and SCC. The time between the most recent Pap smear and the diagnosis of cervical cancer was significantly shorter for patients with AC (P=0.01). Patients with AC had Pap smears more regularly than those with SCC, and their most recent Pap smear was significantly more likely to be normal. Thus, Pap smear prior to a diagnosis of AC is more likely than SCC false-negative and therefore not indicative of cervical cancer.
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