Was recent screening history linked to cervical cancer stage at diagnosis?

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The researchers investigated cancer screening histories to examine their association with the clinical characteristics of cervical cancer. At one hospital, they reviewed the pre-diagnosis screening histories of 248 patients who were histologically diagnosed with CIN3 or cervical cancer and treated during 2006–2009. Patients were grouped according to whether they had undergone cancer screening at least once in the preceding three years: 92 (37%) had a screening history and 156 (63%) did not.

Stage Ib–IV advanced cancer was significantly more frequent in the group without a screening history: 70.5% (110/156), compared with 19.6% (18/92) in the group with a screening history (p<0.001). Of the 18 patients with a screening history who had stage Ib1 or higher cancer, eight had squamous cell carcinoma (SCC) and ten had adenocarcinoma. Adenocarcinoma accounted for 55.6% of this group, significantly higher than its 20.3% share (26/128) among all invasive cancers at stage Ib1 or higher studied (p<0.001). The researchers interpreted this as a tendency for adenocarcinoma to be missed by cytology.

For SCC, small lesions, inward-growing types and keratinizing types were considered possible factors in false-negative results. The researchers concluded that invasive cancers were sometimes found despite a screening history, and that difficult-to-diagnose cases occurred in both adenocarcinoma and squamous cell carcinoma. Improving diagnostic accuracy for these groups was identified as a future challenge.