The diagnostic process of cervical cancer; areas of good practice, and windows of opportunity

• Only 39% of cervical cancers in this retrospective cohort were ‘screen-detected’.
• Over 50% of tumors are not immediately recognized at gynecological examination.
• An additional excisional procedure, other than a biopsy, was necessary to reveal the diagnosis of cancer in 29% of cases.
• Better early recognition can avoid unnecessary diagnostic procedures.

ObjectiveDespite an extensive screening programme in The Netherlands, some cases of cervical cancer are still diagnosed in late stages of disease. The aim of the present study was to investigate which elements in the diagnostic process of cervical cancer may be improved.MethodsThis is a retrospective study of 120 patients with cervical cancer diagnosed between January 1st 2008 and June 1st 2010 at the University Medical Center Utrecht. Patient charts, referral information, and pathology results were analyzed.Results39.1% of cancer cases were screen or interval detected; the other 60.9% of patients had not been screened, either due to non-attendance or because they fell outside the age range for screening. The final diagnosis of cervical cancer was established by biopsy in 77 (64.2%) and by excision of the cervical transformation zone in 35 (29.2%) of the patients. Fifteen (43%) of these excisions could have been avoided if biopsies would have been taken at the first examination, and had shown invasive cancer.ConclusionsCervical cancer screening aims at early detection of precursor lesions to decrease the incidence of cancer. This in-depth analysis suggests that improvement of quality of care is to be expected from correct recognition of cervical cancer by physicians and adjustments of the screening programme to reach younger women and non-responders.