Cervical carcinoma in the Grampian region (1980–1991): a population‐based study of survival and cervical cytology history

Macleod, Angus; Kitchener, Henry C; Parkin, David E.; Sarkar, T. K.; Miller, Iain D.; Mann, EvelynM.F.; Gordon, N. L. M.; Campbell, Marion K

doi:10.1111/j.1471-0528.1994.tb11949.x

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Thus the patient material beyond stage IA was considered population based. Excluding stage IA, the remaining distribution between stages IB, II, III and IV, was 54%, 18%, 21% and 7%, respectively, quite similar to the stage distribution found in a similar populationbased study from Scotland (6). This favorable stage distribution is in contrast to the situation in third world countries, and may at least partly be due to early detection by cervical smears (7).…”

Section: Discussionsupporting

confidence: 78%

Primary treatment of cervical carcinoma Ten years experience from one Norwegian health region

Hagen¹,

Skjeldestad²,

Halvorsen³

et al. 2000

Acta Obstet Gynecol Scand

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Objective. To study the primary care of cervical carcinoma with regard to clinical and pathological factors, treatment decisions, complications and survival. Design. A historical cohort comprising all women hospitalized with invasive cervical carcinoma (nΩ293) during the period 1987-1996. Results. Median age was 52 years (range 23-90). FIGO stage distribution was 62%, 15%, 18% and 5% in stages I, II, III and IV, respectively. Early stage disease correlated with young age. Histologic types were: squamous cell carcinoma 84%, adenocarcinoma 11%, adenosquamous carcinoma 4% and small cell/anaplastic carcinoma 1%. Primary therapies were: surgery 188 women (64%), radiotherapy 99 women (34%), chemotherapy two women (0.7%); four women not treated (1.3%). Complications after surgery in 25 women (13%), none were fatal. Acute or late complications after primary or postoperative radiotherapy in 39 women (25%), seven (4.6%) were late serious complications. Three women died from complications related to radiotherapy. Mean follow-up of surviving patients was 58 months. Overall disease specific five-year survival was 70%. Five-year survival in stages IA, IB, II and III was 100%, 88%, 58% and 20%, respectively. One-year survival in stage IV was 31%. Median survival in stages III and IV according to curative or palliative aim of treatment was 20 and 6 months, respectively (pϽ0.005).Conclusion. Satisfactory quality of diagnosis and therapy have been maintained through regional care for cervical cancer patients.

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Section: Discussionsupporting

confidence: 78%

Primary treatment of cervical carcinoma Ten years experience from one Norwegian health region

Hagen¹,

Skjeldestad²,

Halvorsen³

et al. 2000

Acta Obstet Gynecol Scand

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“…Cervical cytological screening programmes have improved surveillance within target groups, from 66% in 1988 to 87% in 1994 (Dr Elizabeth MacKenzie, personal communication), which is reflected in the increased screening rates in our 1993 cervical carcinoma cohort. That screening is still not reaching all targeted groups is a cause for concern; the prognosis of cervical carcinoma has been shown to be significantly worse in the absence of previous cytology 8 and our data would suggest that a disproportionate number of cases of cervical carcinoma is now appearing from this small unscreened population. Of interest is the finding that 25% of patients presenting with primary cervical carcinoma are older than 65 years of age and therefore fall outside our screening programme.…”

Section: Discussionmentioning

confidence: 69%

“…Although the implication is that the other 46% never participated in the screening programmes, this conclusion cannot be made with any confidence based on an audit of this type. Indeed, previous smears may have been negative 5–8 . Cervical cytological screening programmes have improved surveillance within target groups, from 66% in 1988 to 87% in 1994 (Dr Elizabeth MacKenzie, personal communication), which is reflected in the increased screening rates in our 1993 cervical carcinoma cohort.…”

Section: Discussionmentioning

confidence: 98%

“…The expert panel felt that all cases of cervical carcinoma other than Stage IA should have a minimum assessment that includes thorough examination (although not necessarily under anaesthesia) and chest radiograph with clear documentation of tumour staging in the hospital notes. It is well established that the stage of disease at diagnosis is an important prognostic factor 8,11,12 , and it was a cause for concern that only 86% of such patients had any record of an examination, with 53% having a recorded clinical staging. Only 42% had a plain chest radiograph.…”

Section: Discussionmentioning

confidence: 99%

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The management of cervical carcinoma within the South West Region of England

Jackson

Murdoch

Howe

et al. 1997

BJOG

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Objective 1, To audit the management of cervical carcinoma in the South West Region with the aim of identifying and addressing deficiencies. 2. To determine whether recent NHS restructuring has affected the provision of cancer care.Design Retrospective review of hospital case notes.Setting All hospitals in the South West Region of England.Population Three hundred and twenty-four women with a diagnosis of cervical carcinoma: 191 wereMain outcome measures Documentation of patient assessment and management.Results There was a mean delay of 17 days (range 0-66) from cervical smear to cytology report and 34 days (range 1-380) from general practitioner referral to attendance at a hospital clinic. Overall, 175 women (54%) had evidence of cytological assessment prior to treatment and 137 (42%) had a colposcopic assessment; 49% had cytological assessment and 37% had colposcopy in 1989, compared with 60% and 50%, respectively, in 1993. Excluding 49 cases of micro-invasive carcinoma, 238 case notes (86%) contained evidence of clinical examination; 195 women (71%) had had an examination under anaesthesia, 1 15 (42%) a chest radiograph, 123 (45%) an intravenous urogram or renal ultrasound, and 92 (33%) cystoscopy. One hundred and forty-seven women (53%) had FIG0 staging recorded in the notes. As first line treatment, 69 had conservative surgery (39 for Stage IA), 138 had radiotherapy, and 107 had radical surgery. Ten had radical surgery for Stage IA but eight had a > 3 mm invasion or lymphatichascular spread. Thirty-one had Stage IB treated with radiotherapy of whom 14 were younger than 50 years of age. Following radical surgery 30% had evidence of sampling 2 10 nodes, and 9% had tumour extending to the resection margins.Conclusions Record keeping was inadequate but appeared to indicate inconsistent cytological, clinical, colposcopic and radiological assessment, leading to inappropriate clinical delays and conservative surgery. Radical surgery often appeared inadequate, but poor node sampling rates may also reflect insufficient histopathological preparation or reporting. There was a reduction in the number of new cases of cervical carcinoma diagnosed in 1993, perhaps reflecting an observed increase in cytological surveillance. No other alterations in clinical practice were observed over the four-year period. We feel it is imperative to standardise assessment throughout the region with a minimum clinical and histopathological dataset.diagnosed in I989 and 133 in 1993.

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“…Similarly, the mean age of both micro-and frankly invasive cervical cancer is also declining with studies showing the mean age at diagnosis being at the early 30s and 40s respectively (1,2) . Therefore, it is not unusual for the clinician to deal with a diagnosis of microinvasive cervical cancer (FIGO, stage IA) (3) in women who have yet to complete their families.…”

mentioning

confidence: 98%

Large loop conization for early invasive cervical cancer

Paraskevaidis

Kitchener

Kalantaridou

et al. 1997

Int J Gynecol Cancer

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The objective of this prospective study was to manage microinvasive cervical cancer (FIGO stage IA) using large loop conization. Cytologic, colposcopic, and histologic findings in women with microinvasion who were managed with large loop conization during 1990–94, are presented together with fertility and pregnancy outcome. A histologic diagnosis of microinvasion was made following large loop conization in 42 women. Histopathology showed a depth of invasion less than 3 mm in 35 cases. In the absence of lymphvascular space involvement, conservative management by means of intensive cytologic and colposcopic surveillance, was adopted in 29 women. The mean age of these women was 30.6 (±3.5) years (range 24–36 years of age) and all women completed at least 25 months of follow‐up. During the study period 19 women became pregnant. It was concluded that large loop conization can be an alter‐native method of treatment in cervical microinvasive cancer with depth of invasion less than 3 mm and no lymphvascular space involvement, especially in young women who wish future fertility.

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Cervical carcinoma in the Grampian region (1980–1991): a population‐based study of survival and cervical cytology history

Cited by 9 publications

References 18 publications

Primary treatment of cervical carcinoma Ten years experience from one Norwegian health region

Primary treatment of cervical carcinoma Ten years experience from one Norwegian health region

The management of cervical carcinoma within the South West Region of England

Large loop conization for early invasive cervical cancer

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