Poor Cervical Cancer Screening Attendance and False Negatives. A Call for Organized Screening.

Marta Castillo,Julio Velasco,Raquel Ibáñez,Omar Clavero,Silvia De Sanjosé,Aurora Astudillo,Marcia Edilaine Lopes Consolaro

doi:10.1371/journal.pone.0161403

Abstract

ObjectiveThe objective of this study was to describe prior negative screening history and symptoms around the time of diagnosis of incident cervical cancer (CC) cases diagnosed between 2000 and 2010 within the Asturias public health system.MethodsRecords from 374 women diagnosed with CC between 2000 and 2010 from all public hospitals in Asturias were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Inter-observer agreement in cytology was checked by comparing concordance values using k-statistics.ResultsNo prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage. Advanced stage (e.g., ≥ II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC). False negative smears were identified in 27.1% of women with CC (ADC 52.6% vs. SCC 16.2%, p<0.05).ConclusionsAbsence of prior screening history was common among CC cases. Organized actions to reduce “under screening” and the use of highly sensitive HPV-based tests could be useful strategies in reducing the burden of CC in Asturias.

Highlights

Cervical cancer (CC) is one of the most common and lethal malignancies among women worldwide [1]
No prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage
Advanced stage (e.g., II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC)

Summary

Introduction

Cervical cancer (CC) is one of the most common and lethal malignancies among women worldwide [1]. CC mortality has been reduced by 70–80% through early detection in population-based Pap screening programmes that have high coverage [2]. European Union (EU) recommendations suggest that high population impact can be reached by organizing screening activities using cost-effective interventions. Several scientific societies in Spain have recently published recommendations for implementing organized population-based CC screening and introducing HPV testing as a primary screening tool for women aged 30 years and older [3]. The autonomous region of Asturias has the fourth highest incidence of CC in Spain after Tarragona, Mallorca and the Canary Islands—with a crude incidence rate of 9.6 per 100,000 women and mortality of 3.2 per 100,000 [4]. According to a 2008 survey, Asturias has an opportunistic CC screening programme with coverage estimated to be around 60% [5]

Methods

Discussion

Conclusion