Lessons from Cases of Screened Women Who Developed Cervical Carcinoma
R. Marshall Austin, M.D., Ph.D.
Presentation date: January 25, 2011; Expires: January 25, 2014
Although most cervical carcinoma cases in the US are diagnosed in never or seldom screened women, a significant subset of cases continue to be diagnosed in women who have had periodic cytologic screening. These cases represent a tiny subset of all screened cases and a small portion of all cases identified as “abnormal.” The most common cases in this “missed opportunity” category are glandular cervical cancers which occur in younger women, usually younger white women on oral contraceptives. Several such cases will be illustrated. Missed opportunities for the diagnosis of cervical squamous carcinoma most often turn on challenges surrounding identification of squamous cell abnormalities arising in immature squamous metaplastic cells or atrophy, sometimes in Pap tests with few abnormal cells. Multiple slide blinded reviews by staff are emphasized as a key educational technique to educate staff on the potential challenges for cytological recognition of slides in these categories. Emerging knowledge on the ability of HPV testing to enhance screening will also be discussed.