Cervical cytology and the diagnosis of cervical cancer in older women

TY - JOUR

T1 - Cervical cytology and the diagnosis of cervical cancer in older women

AU - Landy, Rebecca

AU - Castanon, Alejandra

AU - Dudding, Nick

AU - Lim, Anita Wey Wey

AU - Hollingworth, Antony

AU - Hamilton, Willie

AU - Sasieni, Peter D

N1 - © The Author(s) 2015.

PY - 2015/12

Y1 - 2015/12

N2 - OBJECTIVES: Most non-screen-detected cervical cancers are advanced stage. We assess the potential for cytology to expedite diagnosis when used outside of routine call and recall screening for cervical cancer.METHODS: Two cohorts of women with cytology that did not appear to have been taken as part of routine screening, nested within a census of cervical cytology, in England between April 2007 and March 2010 were studied: 93,322 women aged 40-69 at first cytology, and 14,668 women aged ≥70. The diagnostic performance of high grade cervical squamous intraepithelial lesion (HSIL) or worse cytology was estimated. We also estimated case-fatality from stage distribution in women aged ≥66 with and without cytology in the year prior to diagnosis.RESULTS: There were 259 cancers diagnosed in women aged 40-69 at first cytology, and 78 in women aged ≥70. The sensitivity of cytology ≥ HSIL for cancer was 89% and 83% respectively, and the number of women needed to test to identify one cancer was 404 (95% confidence interval [CI]: 355-462) and 226 (95% CI: 177-292) respectively. Women aged ≥66 with cytology within a year of diagnosis had earlier stage cancers than those without, corresponding to a 17-22% reduction in case fatality.CONCLUSIONS: Cervical cytology is an excellent identifier of cancer among women tested outside routine screening call and recall. Its use as a triage tool, for instance in women with vague gynaecological symptoms, could facilitate earlier stage diagnosis and reduce cervical cancer mortality.

AB - OBJECTIVES: Most non-screen-detected cervical cancers are advanced stage. We assess the potential for cytology to expedite diagnosis when used outside of routine call and recall screening for cervical cancer.METHODS: Two cohorts of women with cytology that did not appear to have been taken as part of routine screening, nested within a census of cervical cytology, in England between April 2007 and March 2010 were studied: 93,322 women aged 40-69 at first cytology, and 14,668 women aged ≥70. The diagnostic performance of high grade cervical squamous intraepithelial lesion (HSIL) or worse cytology was estimated. We also estimated case-fatality from stage distribution in women aged ≥66 with and without cytology in the year prior to diagnosis.RESULTS: There were 259 cancers diagnosed in women aged 40-69 at first cytology, and 78 in women aged ≥70. The sensitivity of cytology ≥ HSIL for cancer was 89% and 83% respectively, and the number of women needed to test to identify one cancer was 404 (95% confidence interval [CI]: 355-462) and 226 (95% CI: 177-292) respectively. Women aged ≥66 with cytology within a year of diagnosis had earlier stage cancers than those without, corresponding to a 17-22% reduction in case fatality.CONCLUSIONS: Cervical cytology is an excellent identifier of cancer among women tested outside routine screening call and recall. Its use as a triage tool, for instance in women with vague gynaecological symptoms, could facilitate earlier stage diagnosis and reduce cervical cancer mortality.

KW - Adult

KW - Aged

KW - Cervical Intraepithelial Neoplasia

KW - Cytological Techniques

KW - Early Detection of Cancer

KW - England

KW - Female

KW - Humans

KW - Mass Screening

KW - Middle Aged

KW - Sensitivity and Specificity

KW - Uterine Cervical Dysplasia

KW - Uterine Cervical Neoplasms

KW - Vaginal Smears

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1177/0969141315598174

DO - 10.1177/0969141315598174

M3 - Article

C2 - 26346038

SN - 0969-1413

VL - 22

SP - 207

EP - 212

JO - Journal of Medical Screening

JF - Journal of Medical Screening

IS - 4

ER -