DIAGNOSTIC ASSESSMENTS IN PATIENTS WITH INVASIVE CANCER OF THE CERVIX- A NATIONAL PATTERNS OF CARE STUDY OF THE AMERICAN-COLLEGE OF SURGEONS

Using a standard collection form designed by a multidisciplinary commi ttee of specialists, cancer registrars at 703 hospitals submitted anon ymous data on 11,721 patients with cervical cancer diagnosed during 2 study years, 1984 and 1990, Information concerning the initial use of diagnostic assessments was analyzed with respect to the potential infl uences of clinical stage, patient age, race/ethnicity, insurance statu s, and modalities of therapy employed, Estimates of the yield of diagn ostic information for each test were correlated with clinical stage an d patient age, Judged by the number of procedures performed, the inten sity of pretreatment assessment declined between 1984 and 1990, Substa ntially increased use of the newer body imaging modalities (computeriz ed axial tomography and magnetic resonance imaging) with high probabil ities of revealing abnormalities attributed to cancer, balanced major declines in utilization of procedures historically important in stagin g and assessment (cystoscopy, proctoscopy, barium enema, excretory uro graphy (intravenous pyelogram), bone scintography, and lymphangiograph y). Race/ethnicity and insurance status had no discernible independent impact on the intensity of diagnostic evaluation. Patients with more advanced clinical stages underwent more extensive testing, as did pati ents treated initially with radiation compared to surgery. Periodic re view of assessment strategies would seem prudent to avoid widening dis crepancies between sanctioned staging formalisms with endorsed and aut horized appraisals and actual clinical practice. (C) 1996 Academic Pre ss, Inc.