Adenocarcinoma of the uterine cervix compared with squamous cell carcinoma: a 12‐year study in Southampton and South‐west Hampshire

Abstract

In a 12-year study of the population of Southampton and South-west Hampshire (SSWH), there was no rise or fall in the incidence of adenocarcinoma of the uterine cervix, although the incidence of squamous cell carcinoma fell from 14 to 7.2 per 100000 women years and the overall fall in age-adjusted incidence of cervical carcinoma was commensurate with that of England and Wales. The majority (59%) of adenocarcinomas were seen in women aged less than 50, supporting the concept of a higher risk in young women. Screen-detected carcinomas accounted for 50% of adenocarcinomas and 41% of squamous cell carcinomas in women aged 20-64 (the difference was not significant). There were more screen-detected adenocarcinomas of less than 3 mm depth of invasion and 7 mm lateral extension during the third period of the study (1991-1993). The results are consistent with reports of an increased risk of cervical cancer in women born since 1940, and lesser effectiveness of screening in preventing adenocarcinoma compared with squamous cell carcinoma. High prevalence of early screen-detected carcinomas may have been a factor in recent reports of increased incidence of adenocarcinoma.

Natural history and screening model for high‐risk human papillomavirus infection, neoplasia and cervical cancer in the Netherlands

“…1) was estimated from follow-up data of 290 women in the POBASCAM study that had normal cytology and an hrHPVpositive test (GP5þ6þ PCR-EIA 20 ) at baseline. After 6 months, 37% of the women had cleared the hrHPV infection (95% confidence interval [CI] [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46], which is consistent with published percentages of 39% 36 and 36%. 37 The viral clearance did not depend on age.…”

“…The annual symptom probabilities were computed by simulation on the basis of UK screening and cancer incidence data, 31,32 yielding estimated 6-month symptom probabilities during FIGO stage 1 and stage 2þ of 0.048 and 0.30. The estimates were insensitive to changes in the sensitivity of cytology (varied from 70-90%) and are comparable to symptom rates used in other models.…”

“…26 The progression rate of CIN3 to cervical cancer and the detection rate of cervical cancer were obtained from data collected outside the Netherlands. [27][28][29][30][31][32] The estimates of the model parameters are presented in Table I. A detailed description of the estimation is given below.…”

The value of cervical screening to young women

“…Invasive cancer in young women is rare and nowadays most of the cases are screen-detected. These include microinvasive cancers, which have been excluded by Sasieni et al In the 12-year study of cancers in Southampton between 1985 and 1996, referred to by Sasieni et al, there was a reversal of the ratio of symptomatic: screen-detected cancers in women aged 25 -34 years from 10 : 4 in 1985 -87 to 4 : 8 in 1994 -96, but no fall in the numbers of cancers in that age group (Herbert et al, 2001). This is a clinically important benefit of screening young women because 90% of screen-detected cancers were diagnosed at stage I, giving an excellent prognosis with respect to life expectancy (Herbert et al, 2001).…”

Adenocarcinoma in situ of the uterine cervix

“…4 Nevertheless, Smith et al suggested the possibility of improved prognosis for patients with adenocarcinoma of the cervix in some population groups in recent years, 1,2 perhaps due to earlier disease stage at diagnosis as a result of screening; and Herbert et al demonstrated that screen-detected adenocarcinomas tended to be lower-stage malignancies compared with symptomatic adenocarcinomas, suggesting the occurrence of downstaging due to screening. 5 Sasieni and Adams, in their age-cohort model, demonstrated that the incidence rate in women ages 25-54 years was 40% less than predicted, again suggesting the effects of cervical screening. 4 Among the possible reasons for reduced effectiveness of screening are 1) insufficient sensitivity for detecting precursor lesions, either because of sampling error, false-negative results, or underreporting, and 2) rapid progression from in situ to invasive carcinoma.…”