Of a total of 576 patients with cervical carcinoma in situ, 75 have shown evidence of persistent disease after various initial treatments. None of the 75 have developed invasive cervical cancer during follow-up. This result is used to obtain confidence limits for the probability with which carcinoma in situ will become invasive and for the period after, which it does so. Two separate assumptions about the distribution of latent periods give comparable values for these limits, which imply a low invasive potential in conservatively treated carcinoma in situ.With the further assumption that the treatments used have not altered the course of the disease, the need for any treatment at all and the effectiveness of cervical cytology screening programmes are questioned.
Summary
Cytology screening, used in New Zealand since 1955 at an intensity comparable to that in Canada generally, has not favourably affected incidence and mortality rates for cervical cancer; these have actually risen significantly in 20 to 34‐year‐old New Zealand women. Canadian claims that mortality falls are related to intensity of cytological screening are not justifiable, so that the significance of the‘pre‐cancers’revealed by cytology and the value ofpopulation screening would seem to be doubtful.
Summary
A series of 190 patients with cervical carcinoma in situ has been presented. All have been followed for at least 1 year, and more than half for at least 2 years.
The definitive treatment was total hysterectomy in 106 patients and local excision in 84. Four of the latter patients ultimately had a hysterectomy.
The method of cone biopsy used, and some of its complications, are described.
Of the patients who underwent hysterectomy one had positive vaginal smears after operation.
Eleven of the conservatively‐treated patients showed evidence of persistent disease and one with incomplete follow‐up is assumed to have it also. The investigation and outcome of these patients are considered in detail; all except one are cytologically free of disease at present.
The relative efficiency of the various types of biopsy, in completely excising a carcinoma in situ, is discussed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.