Frequency and Outcome of Cervical Cancer Prevention Failures in the United States

Abstract

We measured the frequency and outcome of cervical cancer prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous cancers (1 in 187,786 Pap tests), glandular cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that cervical cancer prevention practices are remarkably successful in preventing squamous cancers, although a high frequency of failures results in low-impact negative outcomes.

Cytohistological correlation and discrepancy of conventional Papanicolaou smear test with corresponding histopathology: a retrospective study over a 5-year period

“…Despite the lack of a standardized method for the cytohistological correlation of cervical lesions, many studies show that this correlation gives a high detection rate (8)(9)(10)(11). In fact, it is considered to be a method to detect medical error in the histopathology laboratory (12).…”

Dynamic Spectral Imaging: Improving Colposcopy

“…However, the efficacy of the entire diagnostic chain is constrained by the low sensitivity of colposcopy (3, 5 -9) and by low levels of intraobserver and interobserver agreement (10). As a result, colposcopy is responsible for 52% of screening failures, including missed lesions, unnecessarily repeated tests, and diagnostic delays (11). To fully exploit the benefit of increased screening sensitivity, the performance of colposcopy must be improved (3).…”

Protein profile analysis of cellular samples from the cervix for the objective diagnosis of cervical cancer using HPLC-LIF

“…The reported sensitivity and specificity of Pap cytology to detect HSIL (high-grade squamous intraepithelial lesion) in over 15 retrospective and prospective randomized trials have been 55% and 98%, respectively [1]. In developed countries, Pap smear screening programs have reduced incidence of cervical cancer by up to 90% and has decreased cancer mortality substantially [2,3]. It has been reported that the majority of women who develop cervical cancer never had a Pap test or did not have a recent Pap test [4][5][6].…”