Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
J Low Genit Tract Dis. 2011 Apr;15(2):110-3. doi: 10.1097/LGT.0b013e3181f515a2.
It has been reported that approximately 50% of invasive cervical malignancies are diagnosed in patients who have never been screened and that 10% of the remaining cervical cancer patients have not had a Pap smear in the 5 years before diagnosis. We sought to determine whether this holds true among a university-based gynecologic oncology patient population.
After institutional review board approval, a retrospective chart review of women in a university-based gynecologic oncology group with cervical cancer from 2002 to 2007 was conducted. Patients' demographics, referral Pap smear, method of diagnosis, histology, clinical stage, treatment, and time since last Pap smear were collected. Descriptive statistics were used during data analysis.
A total of 419 women with cervical cancer were identified. Of these women, 67% of patients were white, 18% Hispanic, and 6% African-American. The most common referral Pap smear to our institution was high-grade squamous intraepithelial lesion (21%). Diagnosis was primarily made by cervical punch biopsy (47%). The most common histologic type was squamous cell carcinoma (70%). Of all patients, 80% were diagnosed with stage I and 9% with stage II cervical cancer, whereas stage III and IV were uncommon. The most common therapy was radical hysterectomy with lymph node dissection performed in 250 patients (60%). The length of time from last reported Pap smear to diagnosis of invasive cervical cancer ranged from 1 to 65 years, with a median of 3 years. Stage IA1 patients ranged from 1 to 12 years from last reported Pap with a median of 1 year (SD = 3.38), whereas stage III/IV patients ranged from 1 to 20 years since last screening, with a median of 4 years (SD = 6.39). Regarding length of time since last reported Pap smear, 235 patients (56%) were unable to report the length of time since their last Pap smear. Of those who reported their last Pap smear, 4 patients (1%) reported never having a Pap smear, 39 patients (9%) reported last Pap smear more than 10 years ago, and 10 patients (2%) reported a Pap smear more than 20 years ago. Of all patients, 85 (20%) reported a Pap smear within 2 years. Of these 85 patients, 71 patients (84%) were diagnosed at stage I, whereas more advanced stages were uncommon.
Traditionally, patients diagnosed with an invasive cervical malignancy are either unscreened or underscreened with cervical cytology. Our patient population was noncompliant with the screening measures. A fraction of our patients were compliant with screening within the last 2 years, yet still developed a cervical malignancy--albeit early stage disease. As such, our data suggest that compliance continues to be an issue. However, even with adherence to screening guidelines, cervical cancer continues to develop.
据报道，约有 50%的浸润性宫颈癌患者从未接受过筛查，而其余 10%的宫颈癌患者在诊断前的 5 年内没有进行过巴氏涂片检查。我们试图确定这是否适用于基于大学的妇科肿瘤患者人群。
在获得机构审查委员会批准后，对 2002 年至 2007 年间在基于大学的妇科肿瘤组中患有宫颈癌的女性进行了回顾性图表审查。收集了患者的人口统计学资料、转诊巴氏涂片、诊断方法、组织学、临床分期、治疗方法以及上次巴氏涂片检查后的时间。数据分析采用描述性统计方法。
共确定了 419 名宫颈癌患者。这些患者中，67%为白人，18%为西班牙裔，6%为非裔美国人。转诊至我院最常见的巴氏涂片检查为高级别鳞状上皮内病变（21%）。主要通过宫颈活检（47%）进行诊断。最常见的组织学类型为鳞状细胞癌（70%）。所有患者中，80%诊断为 I 期宫颈癌，9%诊断为 II 期宫颈癌，而 III 期和 IV 期宫颈癌较为少见。最常见的治疗方法是根治性子宫切除术加淋巴结清扫术，共 250 例（60%）。从最后一次报告的巴氏涂片检查到浸润性宫颈癌的诊断时间为 1 至 65 年，中位数为 3 年。IA1 期患者从最后一次报告的巴氏涂片检查到诊断的时间范围为 1 至 12 年，中位数为 1 年（SD=3.38），而 III/IV 期患者从最后一次筛查到诊断的时间范围为 1 至 20 年，中位数为 4 年（SD=6.39）。关于最后一次报告的巴氏涂片检查的时间，235 名患者（56%）无法报告最后一次巴氏涂片检查的时间。在报告最后一次巴氏涂片检查的患者中，有 4 名患者（1%）报告从未进行过巴氏涂片检查，39 名患者（9%）报告最后一次巴氏涂片检查超过 10 年前，10 名患者（2%）报告最后一次巴氏涂片检查超过 20 年前。所有患者中，有 85 名（20%）报告在 2 年内进行了巴氏涂片检查。在这 85 名患者中，有 71 名患者（84%）诊断为 I 期，而晚期病例则较为少见。
传统上，诊断为浸润性宫颈癌的患者要么未接受过筛查，要么未接受过巴氏涂片细胞学筛查。我们的患者人群不符合筛查措施。我们的一部分患者在过去 2 年内符合筛查要求，但仍患上了宫颈癌——尽管是早期疾病。因此，我们的数据表明，依从性仍然是一个问题。然而，即使遵守了筛查指南，宫颈癌仍在继续发展。
