Abstract
Cervical cancer screening by conventional cytology (CCyto) detects and grades HPV-induced lesion while HPV-PCR detects HPV infection, with potential for earlier diagnosis. Alteration on screening prompts biopsy confirmation, then surgery may be indicated. Here we estimate the impact of screening time on surgical outcomes and their burden. Diagnoses from a private laboratory of Southeast Brazil were retrieved (2017-2018). A subset of 49 patients had been biopsied before surgery at the same institution (average 35.6y (20-68), 73% private health). Data from CCyto was available in a subset of 32/49 women (mean 2.4 exams). PCR-HPV was not available for all patients. Time ranges were calculated (means). A pharmacoeconomic model was chosen to calculate costs comparisons. Women diagnosed as high grade (n=36) were 9.8y older than low grade (n=13). CCyto-surgery interval was shorter in women with ≤2 screening exams (7vs19 months) (p<0.0001). CCyto-Bx interval was longer in private health (11vs2 months) while Bx-surgery was longer in non-private (3.5vs2.6 months)(p <0.04). No time parameter significantly impacted surgical completeness (margin status). However, cases with incomplete surgery had: A) shorter CCyto-Bx (7.4vs10.3 months), which related to higher grade disease at presentation; B) longer Bx-surgery (3.4vs2.7 months), possibly due to treatment access difficulties. The result of the first CCyto (and not first alteration) associated with surgical completeness (p=0.016). All women who entered screening with a benign CCyto (11/32) underwent complete surgery and of 7 incomplete surgeries, 4 presented as high grade. A pharmacoeconomic model was complex in this format and will be developed further. Access to screening is key to curative outcomes, since detection of severe lesions at presentation shortened time to treatment but was implicated in incomplete surgery (positive margins). Multiple cytologies extended screening investigation. PCR-HPV may improve intervals by targeting high risk population and avoiding repetition of suspicious results, saving health costs and patient time.
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