Abstract
ObjectivesMost non-screen-detected cervical cancers are advanced stage. We assess the potential for cytology to expedite diagnosis when used outside of routine call and recall screening for cervical cancer.MethodsTwo cohorts of women with cytology that did not appear to have been taken as part of routine screening, nested within a census of cervical cytology, in England between April 2007 and March 2010 were studied: 93,322 women aged 40–69 at first cytology, and 14,668 women aged ≥70. The diagnostic performance of high grade cervical squamous intraepithelial lesion (HSIL) or worse cytology was estimated. We also estimated case-fatality from stage distribution in women aged ≥66 with and without cytology in the year prior to diagnosis.ResultsThere were 259 cancers diagnosed in women aged 40–69 at first cytology, and 78 in women aged ≥70. The sensitivity of cytology ≥ HSIL for cancer was 89% and 83% respectively, and the number of women needed to test to identify one cancer was 404 (95% confidence interval [CI]: 355–462) and 226 (95% CI: 177–292) respectively. Women aged ≥66 with cytology within a year of diagnosis had earlier stage cancers than those without, corresponding to a 17–22% reduction in case fatality.ConclusionsCervical cytology is an excellent identifier of cancer among women tested outside routine screening call and recall. Its use as a triage tool, for instance in women with vague gynaecological symptoms, could facilitate earlier stage diagnosis and reduce cervical cancer mortality.
Highlights
Global strategies for cervical cancer control include vaccination against high risk HPV types, population screening, and early-stage diagnosis.[1]
This paper considers the use of cervical cytology as an aid to diagnosis of invasive cancer, with the aim of downstaging cancers, outside of routine call and recall for cervical screening
This study suggests that cervical cytology could be an important triage tool for primary care physicians managing women with gynaecological symptoms
Summary
Global strategies for cervical cancer control include vaccination against high risk HPV types, population screening, and early-stage diagnosis.[1] While the first two are currently given appropriate consideration, strategies for down-staging non screen-detected cervical cancer have been overlooked. Cervical cancer in those who are too young to benefit from screening, who are no longer offered screening, or who have not been screened recently is often diagnosed at advanced stage and has poor prognosis. The aim of cervical screening is to prevent cervical cancer, through identifying and treating pre-invasive cervical lesions. In England, it has been shown that one cancer is diagnosed for every 2726 women screened,[2] and that the sensitivity of screening cytology (even at a cut-off of high-grade cytology) to invasive cancer is high
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