When Pap Testing Fails to Prevent Cervix Cancer: A Qualitative Study of the Experience of Screened Women Under 50 with Advanced Cervix Cancer in Canada

Abstract

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.

EMPOWER CERVICAL-1: Effects of cemiplimab versus chemotherapy on patient-reported quality of life, functioning and symptoms among women with recurrent cervical cancer

“…Survival for patients with cervical cancer has improved in high-income countries with better prevention and detection, as well as more effective treatments [2]. Worldwide, there is no current standard of care for recurrent or metastatic cervical cancer after first-line treatment failure, and significant impairments of quality of life (QoL), functioning and symptoms remain [3,4]. In patients with advanced cancer, physical well-being is significantly associated with overall survival, with a 3.7% decrease in risk of death for each unit of improvement in physical well-being [5].…”

Lack of knowledge regarding HPV and its relation to oropharyngeal cancer among medical students

“…Nevertheless, Pap smears cannot detect all HPV-related changes. 13 Hence, robust preventive measures also rely largely on vaccination.…”

“…An equivalent procedure to Pap smear is currently lacking for screening of oropharyngeal cancers. Nevertheless, Pap smears cannot detect all HPV‐related changes 13 . Hence, robust preventive measures also rely largely on vaccination.…”

A Rare Case of Aggressive Atypical Cervical Cancer With Multi-Organ Involvement

“…With Pap screening, early detection is possible and cancerous or precancerous lesions can be addressed before progression to the advanced stage. However, some women still present with cervical cancer having received Pap smear screening [ 10 ].…”