Cervical cytology reported as negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit

Abstract

Summary The relationship between negative cervical cytology reports and risk of adenocarcinoma of the cervix was evaluated in a case-control study of 113 cases and 452 controls. All cases and controls had received at least two negative cytology reports. There was no significant difference between the cases and controls in the number of negative cytology reports or in history of cervical abnormality; while a test for trend in the time since last negative cytology report was significant (P<0.001), the estimated benefit was very modest. Although the estimates of relative protection were higher in women aged less than 35 years than in women aged (Brinton et al., 1987; Parazzini et al., 1988).Case-control studies have become an established method of evaluating screening programmes. The degree to which adenocarcinoma of the cervix can be prevented by cervical cytology screening has not been well defined. While some published case-control studies have included adenocarcinoma cases in their series (Clarke and Anderson, 1979;La Vecchia et al., 1984;Brinton et al., 1987;Olesen, 1988;Celentano et al., 1989;Shy et al., 1989;Cohen, 1993), the cases have been few in number, constituting only a small minority of all cases. One study of 40 patients with adenocarcinomai found no significant difference in self-reported screening history between cases and controls (Brinton et al., 1987). No validation of the screening history was undertaken, and it appears that the time interval since the last negative Papanicolaou smear report was not specifically sought. Three studies have commented that Papanicolaou smear screening appears to be less effective for the prevention of adenocarcinoma than for squamous carcinoma but have not provided separate analyses for adenocarcinoma (Clarke and Anderson, 1979;Olesen, 1988;Shy et al., 1989).We undertook a case-control study to evaluate the duration of low risk for adenocarcinoma of the cervix after negative cervical cytology results. Cases were diagnosed mainly in the 1980s when screening was well established in Australia. Adenocarcinoma of the cervix constituted 13% of all cervical malignancies at the time of the study (Giles et al., 1992

Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20–44 years: the UK National Case–Control Study of Cervical Cancer

“…Adenocarcinomas and adenosquamous carcinomas of the cervix account for about 15% of invasive cervical cancers, and both absolute and relative numbers of adenocarcinomas in screened populations have increased in recent years. This may reflect a cohort effect similar to that seen for squamous cell carcinomas and related to increased exposure to HPV infection in women born since 1960 (Madeleine et al, 2001;Sasieni and Adams, 2001), and the fact that cervical screening may be less effective in detecting adenocarcinomas than squamous cell carcinomas (Clarke and Anderson, 1979;Mitchell et al, 1995;Bergstrom et al, 1999). Their relative rarity has limited attempts to define risk factors for adenocarcinomas and adenosquamous carcinomas of the cervix (Silcocks et al, 1987;Parazzini and La Vecchia, 1990;Kjaer and Brinton, 1993), but several recent controlled studies with relatively large numbers (over 100) of adenocarcinoma cases have provided clearer evidence (Ursin et al, 1994(Ursin et al, , 1996Bjorge and Kravdal, 1996;Thomas and Ray, 1996;Lacey et al, 1999Lacey et al, , 2000Lacey et al, , 2001Madeleine et al, 2001;Munoz et al, 2002;Altekruse et al, 2003).…”

Adenocarcinoma in situ with a small cell (endometrioid) pattern in cervical smears

“…3,4 Evidence exists that Papanicolaou smears do not afford the same degree of protection from the development of adenocarcinoma as they do for squamous carcinoma. [5][6][7] To increase the effectiveness of the Papanicolaou smear in the prevention of adenocarcinoma, it is critical that cytotechnologists and cytopathologists are able to recognize the patterns of presentation of the precursor lesion, adenocarcinoma in situ. It has been shown that AIS smears with groups of small (endometrioid) cells are particularly prone to underdiagnosis.…”

Incidence and survival rate of women with cervical cancer in the Greater Amsterdam area

“…The incidence of cervical squamous cell carcinoma decreased significantly, while no statistically significant change in the incidence of adenocarcinoma was found. Previous studies have reported that cervical adenocarcinoma and its preinvasive stages are diagnosed less efficiently by Pap smear screening than squamous cell lesions (Mitchell et al, 1995;Stockton et al, 1997). In some countries, not only the absence of a decrease in incidence (Sigurdsson, 1993;Nieminen et al, 1995), but also increases in the incidence of cervical adenocarcinoma have been described in the presence of a screening programme (Bergstrom et al, 1999;Hemminki et al, 2001;Liu et al, 2001).…”

“…It has been suggested that the unchanged or even increased incidence of adenocarcinoma of the cervix is the result of systematic underscreening of cervical smears for (pre)malignant changes of adenocarcinoma of the cervix (Parkin et al, 1985;Mitchell et al, 1995;Stockton et al, 1997). Moreover, patients with adenocarcinomas of the cervix are considered to have a decreased survival compared to patients with squamous cell carcinomas (Hopkins and Morley, 1991;Lai et al, 1999;Nakanishi et al, 2000;Grisaru et al, 2001).…”