Efficacy of screening for cervical squamous and adenocarcinoma. The dutch experience

Abstract

The nationwide screening program for cervical carcinoma in The Netherlands was unique in that all women between the age of 35 and 55 years were individually invited to undergo a cervical spatula smear. The total rate of positive histologic findings in six regions of the country was 3.9 per thousand, and decreased in the second screening after 3 years with 48% of patients. Further analysis of the change in rates of the separate histologic subgroups in six regions revealed: Severe dysplasia showed no change in rates. The rates of carcinoma in situ and invasive squamous cell carcinoma were influenced clearly by the screening. The preinvasive stages of adenocarcinoma of the cervix were underdiagnosed in the first screening, and there was no decrease in the score of invasive adenocarcinoma. The rates in the six regions differed significantly and were dependent on the degree of urbanization. Cervical screening using the Ayre spatula is not effective for detecting cervical adenocarcinomas.

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.…”

Differential expression of MUC2 and MUC5AC in benign and malignant glandular lesions of the cervix uteri

“…First described by Friedell in 1953 [7] and subsequently shown to have a propensity for late recurrence and the development of invasive adenocarcinoma [22], ACIS represents approximately 9-25% of adenocarcinomas of the cervix [5,14], which account for 8-26% of cervical carcinomas [11,20,21]. Patients with ACIS have a similar epidemiologic profile to those with invasive adenocarcinoma of the endocervix [3,4,16].…”

Can glandular lesions be diagnosed in pap smear cytology?

“…47 On the other hand, Ashfaq et al reported that the ThinPrep method provided more accurate diagnoses of glandular disease. 11 Although most reports seem to attribute sampling as the cause for the low Pap smear sensitivity of adenocarcinoma in situ, 11 Lee et al reported that there are an appre-ciable number of screening and interpretive errors. 49 Lee et al reported that the sensitivity of diagnosing adenocarcinoma in situ on conventional smears was 40 -68%, and sensitivity increased on rescreening.…”