Audit of deaths from cervical cancer: proposal for an essential component of the National Screening Programme.

Abstract

Aims-To ascertain the type and relative frequency of major factors associated with deaths from cervical cancer.Methods-Deaths from cervical cancer in Rotherham district for the period [1989][1990][1991] were subjected to multifactorial audit by reviewing laboratory, hospital, and general practitioner records; together with, when appropriate, re-screening of cytology smears. This period represented the three to five years after a computerised National Screening Programme (NSP) Audit of factors associated with deaths from cervical cancer should be a vital part of assessing the effectiveness of the National Screening Programme (NSP). Furthermore, if the Health of the Nation target is to be met (20% reduction of invasive cervical cancer by the year 2000), it is likely that any major problems revealed by audit will require rectification. To date, information on factors contributing to cervical cancer is derived from a relatively small number of studies, each having tended to analyse one specific aspect.'6 Although these have been extremely valuable, surprisingly little is known about the relative frequencies of the different factors in the population. There is currently no national requirement to audit cervical cancer deaths and little attention has been paid to the impact of the NSP on factors associated with death from cervical cancer. For these reasons, a multifactorial district audit of cervical cancer deaths for the period 1989-1991 was undertaken. This period represented the three to five years after a computerised NSP in Rotherham based on a five year recall interval had been introduced.

Primary screening for cervical cancer precursors by the combined use of liquid-based cytology, computer-assisted cytology and HPV DNA testing

“…Studies carried out elsewhere have also confirmed that the Pap smear is not a highly effective primary screening test in the detection of cervical cancer and its precursors (Koss, 1989). It was found that 40% of cervical cancers occur in women who recently received negative test results (Slater et al, 1994), and that a single Pap test misses up to 50% of cervical cancer precursors (Federal Study, 1999). In England and Wales, 47% of the invasive cervical cancer found in women under the age of 70 years occur despite an apparently adequate screening history (Sasieni et al, 1996).…”

The management of cervical carcinoma within the South West Region of England

“…Of interest is the finding that 25% of patients presenting with primary cervical carcinoma are older than 65 years of age and therefore fall outside our screening programme. Slater et al 9 reported similar findings in an audit of deaths from cervical cancer and suggested extending screening to women older than 65 with no cytology record; such an age group is thought unlikely to develop primary cervical carcinoma if prior screening at a younger age has been normal 10 . Our findings may represent previous inadequate cytological surveillance of this age group, and perhaps one would expect a cohort effect as an improved screening programme is implemented and the effects feed through to older age groups.…”

Immunocytochemical Detection of p16INK4a Protein in Scraped Cervical Cells

“…3,4 Indeed, an unacceptable number of invasive cancers in women participating in screening programs has been observed 5,6 ; some cases have been fatal after a negative Pap result. 7 False negatives are a serious concern. In a recent systematic survey of the accuracy of cervical cytology, only 12 studies had appropriate data.…”