Implementing the national invasive cervical cancer audit: a local perspective

• Published in: BJOG : an international journal of obstetrics and gynaecology 2010-10, Vol.117 (11), p.1411-1416
• Main Authors: Moss, EL, Pearmain, P, Askew, S, Owen, G, Reynolds, TM, Prabakar, IM, Douce, G, Parkes, J, Menon, V, Todd, RW, Redman, CWE
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - prevention & control; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - prevention & control; Cervical cancer; Effectiveness studies; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Mass Screening - organization & administration; Medical Audit; Medical sciences; Medical screening; Middle Aged; Patient Compliance; Retrospective Studies; screening programme; Tumors; United Kingdom; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears; Young Adult
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2010.02679.x

Please cite this paper as: Moss E, Pearmain P, Askew S, Owen G, Reynolds T, Prabakar I, Douce G, Parkes J, Menon V, Todd R, Redman C. Implementing the national invasive cervical cancer audit: a local perspective. BJOG 2010;117:1411–1416. Objective  To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care. Design  Retrospective study. Setting  A university hospital serving a population of 1 million people. Population  All women diagnosed with a cervical cancer between 2003 and 2006. Methods  Analysis of data from invasive cervical cancer reviews. Main outcome measure  Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification. Results  Eighty‐seven women were diagnosed with cervical cancer during the 3‐year study period. The ‘lapsed attender’ group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow‐up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage‐II or above, compared with the screen‐detected cases: 60% were stage II or above, compared with 13.0%, Chi‐square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases. Conclusions  The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow‐up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.