Presentation and screening history of indigent women with cervical cancer: Implications for prevention

Objective. To identify missed opportunities for screening and early diagnosis of indigent patients with cervical cancer. Materials and methods. The authors conducted a retrospective review of charts and databases for demographic information, presenting symptoms, staging data, prior health system contacts, and Papanicolaou smears. Women with cervical cancer were evaluated at an urban public hospital between July 1, 1994, and March 31, 1998. Results. Among 177 women with cervical cancer where record could be retrieved, 82 were in stage I, 49 were in II, 25 were in III, and 11 were in IV. Symptoms attributable to cancer were present in 153 (86%) cases, but asymptomatic women were more likely to have stage I cancers (21 of 23 versus 70 of 153, p < .0005). Only 54 (31%) women had prior visits recorded, with emergency services the most common site for visits. Only 23 (43%) of these had prior cytology recorded, four of which were false negatives. Stage I cancers were found in 18 (78%) of these women, compared to 13 (42%) of the 31 women previously seen without a recorded Papanicolaou smear (p < .02). Women with prior visits to gynecology services or clinics were more likely to have Papanicolaou smears recorded (10 of 13 versus 9 of 32 at other sites, p < .0005) but not more likely to have stage I cancer (10 of 13 versus 20 of 41, p = .08). Conclusions. Further reductions in cervical cancer rates are likely to require outreach, screening in nontraditional sites, and refinement of public sector screening programs.