REVIEW OF THE SCREENING HISTORY OF ALBERTA WOMEN WITH INVASIVE CERVICAL-CANCER

Objective: To conduct a failure analysis of cervical cancer screening among women with invasive cervical cancer in Alberta. Design: Descript ive study. Review of demographic, staging and treatment information fr om cancer registry records; generation of documented screening history from Alberta Health billing records and self-reported history from su bjects who agreed to be interviewed; and comparison of findings in ini tial cytology reports with those from subsequent review by at least 2 pathologists of all cytology slides for each patient for the 5 years b efore diagnosis. Cases were assigned to 1 of 6 categories of identifie d screening failure. Setting: Alberta. Subjects: All women with diagno sis of invasive cervical cancel reported to a population-based provinc ial cancer registry from January 1990 to December 1991.Outcome measure s: Demographic, staging and treatment information; documented and self -reported screening histories; correlation oi test results in initial cytology report with those generated from slide review; category of id entified screening failure. Results: Of the 246 women identified with invasive cancer of the cervix, 37 (15.0%) had stage IA disease; 195 (7 9.3%) had squamous-cell carcinoma, and 35 (14.2%) had adenocarcinoma. According to the categories of screening failure, 74 women (30.1%) had never been screened, 38 (15.4%) had not been screened within 3 years before diagnosis, 42 (17.1%) had had a false-negative cytology result, and 20 (8.1%) had been managed outside of conventional protocols. Of the 23 women (9.3%) who had been screened appropriately and had true-n egative results, 19 had smears that were considered technically limite d. It was not possible to classify 49 (19.9%) of the cases. Agreement between the documented and the self-reported screening histories was e xact for only 39 (36.1%) of the 108 women interviewed. Conclusions: De spite widespread use of opportunistic cervical screening, many women i n Alberta are still not being screened adequately. In most cases women are being screened too infrequently or not at all. Self-reported scre ening histories are unreliable because many women may overestimate the number of smears. An organized approach to screening, as recommended by the National Workshop on Cervical Cancer Screening, may assist in r educing the incidence of invasive cervical cancer.