Pathways to diagnosis of cervical cancer: screening history, delay in follow up, and smear reading

Background  The aim of this study was to determine the most important ways to reduce incidence of and mortality from cervical cancer by a nationally co‐ordinated screening programme. Design  Descriptive study. Setting  The New Zealand National Cervical Screening Programme: a nationally organised and co‐ordinated programme. Sample  Women aged younger than 80 years with histologically proven primary invasive cervical cancer, including microinvasive disease, diagnosed between 1 January 2000 and 30 September 2002. Consent for access to medical records was gained for 371 of 445 eligible women (83%). A total of 359 (81%) of eligible women or their next of kin consented to interview. Methods  Data on events prior to diagnosis were obtained from routine sources, interview, medical record review and slide reread. Main outcome measures  Frequency of screening in the 7 years prior to diagnosis, time from abnormal smear or symptoms to appropriate diagnostic confirmation, proportion of negative smears upgraded to high grade on reread. Results  Half of the 371 participants (83% of 445 eligible women) had not had a screening smear in the 3 years prior to diagnosis, and 80% were defined as inadequately screened. A maximum of 17% of women overall or within any defined subgroup experienced delays in follow up of abnormal smears or bleeding. Only 11% of women overall had had a high‐grade smear, which was originally read as negative. Conclusions  The most important factor in women’s pathways to a diagnosis of cervical cancer was inadequate screening. While delays in diagnosis could be reduced and laboratory performance improved, priority must be given to improving uptake and frequency of screening.