Cervical cancer is still missed, despite the availability of screening

BMJ 2005; 330 doi: (Published 12 May 2005) Cite this as: BMJ 2005;330:1102
  1. Janice Hopkins Tanne
  1. New York

    Failure to be screened is the main reason why women who have comprehensive healthcare insurance still develop invasive cervical cancer, says a large study of the members of seven comprehensive prepaid healthcare plans in the United States, which have a combined membership of more than eight million people.

    Embedded Image

    Squamous carcinoma (above) is easier to detect in screening than adenocarcinoma

    Credit: E WALKER/SPL

    Dr M Michele Manos, lead author of the study, which was published in the Journal of the National Cancer Institute (2005;97: 675-83), said that what is needed is “a reminder system that identifies patients who have gone longer than they should without a test, whenever they interact with the healthcare system, even if they go for optometry.” Dr Manos is senior research scientist at the Oakland, California, division of research of the non-profit healthcare plan provider Kaiser-Permanente.

    Invasive cervical cancer was diagnosed in 833 women who had comprehensive medical records for three years before the diagnosis.

    Although the healthcare plans screened 80% to 86% of women members aged 21 to 64, most of the cases of cervical cancer—464 (56%)—were in women who had not had cervical smear tests in the four to 36 months before their diagnosis. However, 375 (81%) of these women had made at least one outpatient visit to a health plan facility in that 36 month period.

    The test failed to detect cancer that was probably already present in 263 (32%) of the women who had a diagnosis of cervical cancer. Women in this group were nearly twice as likely to have cancers that were not squamous cell cancers—primarily adenocarcinomas. Adenocarcinomas occur higher in the endocervix, and a cervical smear test may not detect the abnormal cells. An expert review is planned of the 199 available tests that were reported as normal in women who developed cervical cancer.

    Failure by either the patient or the healthcare providers to follow up abnormal results was the reason in 106 (13%) of the cases. About 20% of women in this group didn't follow recommendations for further tests.

    Older women and women from poor or less educated areas were more likely to be in the “failure to screen” group.

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