© 1994 Oxford University Press
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Incidence of Invasive Cervical Cancer Preceded by Negative Screening in High-Risk Alaska Native Women
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* Arctic Investigations Program, National Center for Infections Disease, Centers for Disease Control and Prevention 225 Eagle Street, Anchorage, AK 99501, USA
Community ealth Servies, Alaska Area Native ealth Service Anchorage, AK 99501, USA
Division of Cancer Prevention, National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention Atlanta, GA 30333, USA
|| Department of Patology, Alaska Native Medical Center Anchorage, AK 99501, USA
¶ Rigshospitalet, Copenhagen, Denmark
# Department of Pathology, Harborview Medical Center Seattle, WA 98104, USA
** Current address Departemtn of Medicine, Alaska Native Medical Center, Anchorage, AK 99501, USA
§ Current address: American Cancer Society, Atlanta, GA 30329, USA
BACKGROUND: Alaska Native women experience higher invasive cervical cancer incidence and mortality rates than US whites despite a long-standing cancer screening programme including recommendations for annual Pap smears.
METHODS: To determine the frequency and results of cytological screening preceding their diagnoses, a histological and medical record review was completed for 44 of 46 Alaska Native cases of invasive cervical cancer from a defined population. An interval cancer (no prior dysplasia and a negative screening report within 3 years of diagnosis) was determined for 23 women. Mean number of negative reports during the 3- and 5-year intervals before diagnosis was 1.7 and 2.6 respectively. The age-adjusted incidence rate for all cervical cancer was 24.0/100 000 women/year and for interval cancer with single and multiple negative reports during the 3-year interval before diagnosis it was 11.6, and 9.6 respectively. Senssitivity of a Pap smear to demonstrate dysplasia during the year before diagnosis was 51%.
CONCLUSIONS: Annual cytological screening of all Alaska Native women with current methods would provide earlier diagnoses for only an additional 15% of cervical cancer cases. Plausible but unproven explanations indude rapid progression through precursor stages of neoplasia or random screening errors. Improved or ancillary screening methods appear necessary.
Received 1 September 1993