Pap tests in the diagnosis of cervical cancer: Help or hinder?

Publication date: July 2018
Source:Gynecologic Oncology, Volume 150, Issue 1
Author(s): Lauren Philp, Nathaniel Jembere, Li Wang, Julia Gao, Bryan Maguire, Rachel Kupets
ObjectiveTo evaluate the impact of pap tests on the time to diagnosis of cervical cancer.MethodsIn this population-based retrospective cohort study, Ontario women ≥21 years diagnosed with cervical cancer between 2011 and 2014 were identified and database data collected. The presence or absence of a pap test 0–2 years preceding cancer diagnosis was identified. Descriptive and modelling analyses were performed to determine the effect of pap results on cancer diagnosis.Results2002 patients were identified, 75% received a pap test. 1250 patients had known cytology – 13% normal, 8% low-grade and 7.5% suspicious for cancer. Across all FIGO stages at diagnosis, 5–10% of cytology was low grade, 3–11.5% was positive for carcinoma and 4–41% was normal, which increased with advancing stage. For all cytology and FIGO stages (except stage 1A), OBGYNs had a significantly shorter time to diagnosis compared to family physicians. Factors increasing the odds of low-grade cytology were advanced stage (OR 4.5 (2.4–8.0), p < 0.01) and adenocarcinoma (OR 1.5 (1.1–2.1), p < 0.01). Low grade cytology resulted in the longest delay to diagnosis (p < 0.001).ConclusionPap tests are performed frequently in the 0–2 years prior to the diagnosis of cervical cancer which can result in false negative cytology and diagnostic delay in patients with advanced cancers.