Significance of a positive Papanicolaou smear in a well screened population.

Of 35,937 gynecologic cytology specimens obtained from the cervix or vagina at our institution during a three-year period, 18 (0.05%) were reported as malignant; ten of these 18 (56%) positive results were due to carcinoma arising from sites other than the cervix or vagina. The site of the primary lesion was the endometrium in four patients, the ovary in three, the colon in one, and the breast in one; in one patient the site of the primary carcinoma was unknown. In our patient population a a positive Papanicolaou smear was more often indicative of a noncervical than a cervical malignancy. In addition to detecting preinvasive and invasive malignancies of the cervix and/or vagina, an annual cytologic smear may hasten the detection of extravaginal primary carcinomas.