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Cervical cancer still presents symptomatically 20 years after the introduction of a structured national screening programme
Author(s) -
Myriokefalitaki E.,
Potdar N.,
Barnfield L.,
Davies Q.,
Moss E. L.
Publication year - 2016
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12315
Subject(s) - medicine , asymptomatic , cervical cancer , colposcopy , vaginal bleeding , population , stage (stratigraphy) , vaginal discharge , obstetrics , gynecology , disease , cancer , pediatrics , surgery , pregnancy , paleontology , environmental health , biology , genetics
Objective To investigate the pattern of presentation of cervical cancer and to identify the characteristics of women who present symptomatically with cervical cancer. Methods A retrospective study of all cervical cancer cases diagnosed over a 4‐year period. Details of mode of presentation, stage at diagnosis and cytological/gynaecological history were collated. Results In total, 148 cases were identified with a median age of 46 years (range, 20–91 years). In this population, 112 (75.7%) women were within the screening age range. Forty‐eight (33.6%) were asymptomatic at diagnosis and presented through the colposcopy clinic. All asymptomatic women (100%) had stage I disease at diagnosis, compared with 37.2% of the symptomatic group ( P < 0.001). Postmenopausal bleeding was the most common presenting symptom (33%), followed by postcoital bleeding (14.2%), intermenstrual bleeding (12.2%) and increased vaginal discharge (3.4%). The majority of symptomatic women presented through colposcopy, gynaecological oncology or gynaecology clinics (87.6%); however, 6.5% presented through the emergency department. Women who presented symptomatically were significantly older than asymptomatic women (54.9 versus 38.1 years, P < 0.001). Women at risk of social isolation (non‐English speakers, alcohol abusers, heavy smokers, receiving treatment for psychiatric disease) were more likely to present with symptoms, through the emergency department and with advanced disease at diagnosis (stage II+) ( P < 0.001). Conclusions A review of local cervical cancer cases can highlight areas of weakness in a screening programme and can identify populations who are at risk in presenting symptomatically with advanced disease.