Review of invasive cervical cancers and uptake of disclosure of results: an audit of procedures and response

Interval cancer audit and disclosure in cervical screening programmes: An international survey

BACKGROUND

Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit.

METHODS

A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients.

RESULTS

Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable.

CONCLUSION

The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.

[Evaluation of mortality after the analysis of the screening history in women diagnosed with infiltrating cervical cancer]

Objetivo

Evaluar el impacto de la ausencia de cribado en la incidencia de cáncer de cuello uterino durante el periodo 2000-2010 en el Principado de Asturias.

Diseño

Estudio retrospectivo.

Emplazamiento

Todos los hospitales públicos de Asturias.

Mediciones principales

Fueron revisadas 374 historias clínicas de mujeres diagnosticadas de cáncer de cuello uterino. La información clínica, el estadio FIGO y los datos de las citologías previas fueron obtenidos de las historias clínicas e informes de anatomía patológica. Se realizó análisis bivariante utilizando el test de chi-cuadrado de Pearson y regresión logística para el cálculo de odds ratio e intervalos de confianza al 95%.

Resultados

El 65,6% de las mujeres diagnosticadas de cáncer de cérvix entre los 25 y los 70 años no habían realizado una citología en al menos los 5 años y medio anteriores al diagnóstico. Este porcentaje se relacionó con la mayor edad al diagnóstico, la presencia de síntomas asociados y con un estadio tumoral avanzado en el momento del diagnóstico. En las mujeres diagnosticadas con una edad mayor de 70 años se objetivó que el 83,3% no habían realizado ninguna citología con anterioridad al momento del diagnóstico.

Conclusión

La implantación de un buen programa de cribado de cáncer cervicouterino y una calidad óptima del sistema en cada uno de los procedimientos que lo integran contribuiría a disminuir la incidencia y la mortalidad por cáncer de cuello uterino en Asturias.

Disclosing the results of the invasive cervical cancer review to patients: a survey of lead colposcopists across England

OBJECTIVE

To survey lead colposcopists to explore the extent to which patients are currently being invited to discuss the results of their invasive cervical cancer review, the reasons why this might not be happening and the clinician experience.

METHODS

An online survey was sent to lead colposcopists across England. They were asked whether they offered the review to patients, if they did how they did so and what their experience was and if they did not, why not.

RESULTS

There was a 68.5% (N = 122) response rate, with 53% of respondents currently offering the review meetings. Patients were predominantly invited to the review meeting face to face and clinicians' experiences were mixed with a variety of positive and negative aspects of the meetings given. For those clinicians not currently offering a review meeting, there were a variety of reasons: 25% cited a lack of awareness of the guidelines, 19% time constraints, 12% a fear of causing additional distress and 2% a fear of litigation. Open-ended responses demonstrated a considerable amount of misunderstanding about the process.

CONCLUSION

Despite National Health Service Cervical Screening Programme guidelines, not all clinicians offer review meetings to patients and those who do offer them do not always offer them to all women. Patient research needs to be conducted to explore the value of the meetings further, and there is a need to do more to engage clinicians in the process.