Introduction: While Papanicolaou (Pap) smears have resulted in a significant decline in cervical cancer incidence and mortality, our clinical experience indicates some women still present with locally advanced cervical cancer (LACC) despite having received Pap smear screening. Recent guidelines have decreased the recommended frequency of Pap smears to every three years. Our study sought to investigate the experiences of young women compliant with cervical screening who presented with LACC.Methods: Women under 50 with LACC, FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IVA who underwent a Pap smear within two years of diagnosis and received curative intent chemoradiotherapy between September 2010 and December 2012 were included. Participants were treated at a tertiary academic cancer centre and invited for a semi-structured, in-person interview, which was analysed qualitatively using thematic analysis.Results: Thirteen out of 38 women had Pap screening two or less years before diagnosis. Ten consented to participate in an interview. Several key themes emerged: I) Belief that LACC does not occur in those who undergo screening; II) Lack of understanding about LACC symptoms/diagnosis of cervix cancer; III) Reluctance from health care providers to perform a detailed pelvic examination in the presence of symptoms; IV) Negative emotions including anger, shame, regret, mistrust; V) Changes in quality of life from treatment; VI) Advice for other women.Conclusions: One-third of women presenting with LACC had appropriate Pap screening prior to diagnosis. Patients believe delays in their diagnosis resulted in detrimental quality of life. There is a need to educate physicians and the public about the symptoms of cervix cancer and to consider this diagnosis even when Pap screening has occurred.

BackgroundScreening programs for cervical cancer in developed countries have led to a marked reduction in mortality given their ability to detect early stage disease. Despite this success, there remains a concerning number of women compliant with regular screening that are diagnosed with advanced disease – a particularly devastating diagnosis for young women given the sexual and reproductive consequences. To explore the reasons behind this shortcoming, the present study sought to identify diagnostic commonalities amongst young women compliant with screening who presented to a tertiary cancer hospital with locally advanced cervical cancer (LACC).MethodsA review of all women (age<50) with LACC receiving definitive chemoradiation between Sept/10‐Dec/12 at our institution was performed to identify those with a routine Pap test done ≤2y prior to diagnosis. Eligible women were offered semi‐structured, face‐to‐face interviews focusing on 4 areas: presenting symptoms, experience with the health care system, feelings after diagnosis, and perception of their future. Interviews were audiotaped, transcribed and a constant comparison analysis was performed to identify key themes. Thirteen out of 38 women (34%) with LACC were compliant with screening prior to diagnosis and met the other study criteria (median age: 38 (27–49)). All had a normal Pap, except one, completed 11 months prior to diagnosis. Ten consented to participate in an interview.ResultsSeveral key themes were identified: a lack of understanding about the symptoms/diagnosis of cervical cancer and a belief that LACC does not occur in those compliant with screening, reluctance from health care providers to perform pelvic examinations, the emotional burden of diagnosis on both the patient and their families and lessons learned with a different outlook for the future.ConclusionsThere is a need to educate physicians and the public about cervical cancer, even where screening is available. Delay in diagnosis has detrimental effects on quality of life and likely prognosis.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.