Diagnosis of Advanced Cervical Cancer, Missed Opportunities?

Abstract

Background Cervical cancer is common worldwide but despite the existence of primary and secondary prevention strategies, the survival rate is decreasing in France. This survival rate is impacted by the increasing proportion of advanced-stage cancer. Our objective was to determine the factors associated with a diagnosis of advanced-stage cervical cancer in an urban population in France Methods A retrospective study was conducted on all consecutive records of patients diagnosed with cervical cancer between January 2006 and December 2018 in a single center in Paris. The data collected were demographic characteristics, medical and gynecological history, circumstances of diagnosis, diagnostic and therapeutic management. The patients were divided into two groups according to the FIGO 2018 stage at diagnosis: group A stages Ia 1 to Ib2 and group B advanced stages Ib3 a to IV. Results From 2006 to 2018, among 96 patients who were diagnosed with cervical cancer, 25 (26%) were in group A and 71 (74%) in group B. Women in group B had less frequently received regular gynecological care than in group A (36.9% vs 84.2%, p < 0.001) and a fewer had Pap test screening in the previous 3 years (30.4% vs 95.0%, p < 0.001). Parity greater than 3 was more frequent in group B (69.6% vs 42.9%, p = 0.031). The diagnosis was made during a routine examination or cervical smear in only 9.23% and 16.18% respectively in group B, vs 60 % of cases in 45.82% of cases in group A (p < 0.001 and p = 0.003). Vaginal bleeding was observed in 85.29% in group B vs 36% in group A (p < 0.001). Histological type was squamous cell carcinoma 87.32% of group B and 56% of group A (p < 0.001). Conclusion Diagnosis of cervical cancers at advanced stages was mostly in women who did not benefit from the recommended screening. Universal access to screening is necessary for the prevention and early treatment of cervical cancer.