Cervical Cancer Issues

Pap Test Misses Some Cervical Cancer

Although the Pap smear has spurred a sharp decline in cervical cancer deaths since it was introduced more than 50 years ago, the test may not pick up one particular type of cervical cancer, new research suggests.

Since 1973, the incidence of adenocarcinoma of the cervix has increased 30%, despite a steep decline in a more common form of cervical cancer known as squamous cell carcinoma, researchers report. While squamous cell cancer arises from the lining of the cervix, adenocarcinoma forms in cervical glands, making it harder to detect. The fact that adenocarcinoma is becoming more common suggests that current screening for cervical cancer may be insufficient, researchers report in the August issue of Gynecologic Oncology.

Dr. Harriet O. Smith of the University of New Mexico Health Sciences Center in Albuquerque led the study.

Looking at federal cancer statistics, Smith's team found that the incidence of all cervical cancers fell 37% between 1973 and 1996. The incidence of squamous cell cancer dropped 42%. In contrast, adenocarcinoma jumped 30%. This, the researchers report, shows that available screening methods may be 'insufficient to detect a significant number of lesions that are precursors to invasive cervical adenocarcinoma.' Better methods that target cervical glands are needed, Smith and her colleagues conclude.

'Additional techniques need to be investigated to improve the sensitivity and specificity of the Pap smear,' Smith noted in a statement. 'For example, liquid-based cytology, such as Thin Prep, may be more accurate than the traditional Pap smear in detecting endocervical cells. Its role in screening for adenocarcinoma of the uterine cervix needs to be more clearly defined.'

However, Smith stressed, '(Women) should know that in almost all cases, cervical cancer is a preventable disease. Having regular Pap tests and compliance with follow-up of an abnormal test virtually guarantees that no woman has to die from this disease.'

Women of all ages, she said, should have an annual Pap smear. The team notes that in the past, adenocarcinoma of the cervix was thought to affect older women, but the data shows it is now increasing among younger women. 'Factors that can increase the risk include immunosuppression, beginning sexual intercourse at a young age, multiple partners, and partners who are themselves at risk for sexually transmitted diseases,' according to a press release from the Gynecologic Cancer Foundation.

September is Gynecologic Cancer Awareness Month. More information is available on the Gynecologic Cancer Foundation's Women's Cancer Network Web site at www.WCN.org.

SOURCE: Gynecologic Oncology 2000;78:97-105

From Reuters Health, 9/00


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