J.Elizabeth Macgregor

MORTALITY FROM CARCINOMA OF CERVIX UTERI IN BRITAIN

A review of age-specific mortality-rates from cervical cancer in England and Wales and in Scotland in 1968--76 shows a decline, striking at some ages. In England and Wales, however, there has been an increase at ages 25--34 and, possibly, at 15--24. Signs of such an increase are also seen in Scotland for the age-groups 25--34 when figures for two regions with well-established screening programmes are removed. Indeed trends in these regions compared with those for the rest of Scotland support the benefit of cervical screening.

UTERINE CERVICAL CYTOLOGY AND YOUNG WOMEN

9000 women aged 20 years and under who had cervical smears taken in the 10-year period 1967-76 were studied. The number of young women with abnormal smears rose, but this increase was in proportion to the number screened. Abnormal smears were found in 145 (1.6%) cases. Follow-up for periods of up to 10 years showed that in over half the cases subsequent smears had reverted to normal without treatment. 19 of the 145 patients progressed to have smears which were suggestive of malignancy: 16 of these were diagnosed histologically as carcinoma-in-situ, and the other 3 were histological dysplasias. At follow-up no cases of carcinoma-in-situ were found in women under 21. No cases of invasive cancer were found on the initial biopsy. One microinvasive cancer was found in a woman aged 26 on a second biopsy 6 1/2 years after the first atypical smear. The preclinical cases were detected from smears taken during pregnancy, or, in the case of the one possibly nulliparous girl, during a gynaecological consultation. These women did not attend family-planning clinics until after a pregnancy.

Improved prognosis of cervical cancer due to comprehensive screening.

Abstract The first ten years of a cervical-screening programme in Aberdeen are reviewed. Coverage in the under-sixty age-group is now 97.3%, and 313 preclinical cases have been detected. Clinical cases have not, however, been eradicated—30 presented in 1968 and 1969—but the effect of screening on five-year survival, especially in younger women, is encouraging.

CERVICAL CARCINOMA: The Beginning of the End ?

Abstract A comprehensive screening programme for cervical cancer in Aberdeen and the North-East of Scotland showed a detection-rate of 0.7% in 56,000 women examined. In the City of Aberdeen 76% of women aged twenty-five to sixty who have been or are still married have been screened. Analysis of the data showed that no microinvasive lesions were found in women below thirty, and no carcinoma-in-situ in women over sixty-five. There was a progressive increase in the percentage of detected preclinical lesions in the microinvasive stage, to a level of 41% over the age of fifty. The highest incidence of positive smears was found ten to nineteen years after first coitus, and the highest incidence of clinical cancer was thirty to thirty-nine years after marriage. The observed incidence of clinical carcinoma of the cervix over many years coincided with the expected incidence if all preclinical cases detected in the same population progressed to clinical cancer. In 1964-66 the number of clinical cases under sixty years of age now presenting have either been detected at an asymptomatic stage in the screening programme or had refused an invitation to have a cervical smear taken some years earlier, or have come from a section of the population which had not been screened. Efficient organisation of screening programmes, routine screening during pregnancy, and rescreening at five-yearly intervals would make clinical cervical cancer a rare disease.

COSTS OF DETECTING AND TREATING CANCER OF THE UTERINE CERVIX IN NORTH-EAST SCOTLAND IN 1971☆

In 1971 the Aberdeen cytology service handled 22,291 cervical smears--threequarters from women participating in a screening programme and the rest from women with symptoms who were referred to hospital. As a result of screening, 56 preclinical cases of cancer of the cervix uteri were treated in hospital; 13 others were classified as less than preclinical. Of the gynaecological patients 20 had clinical cancer and 29 had less than preclinical lesions. From estimates of the costs of running the cytology service and of hospital inpatient costs it is possible to derive figures for detecting and treating preclinical cases and investigating and treating clinical cases. The cost to the Health Service of detecting and treating each preclinical case was slightly less (445 pounds) than that for impatient treatment of each clinical case (487 pounds). However, if mass screening were abandoned cytology would almost certainly continue for women referred to hospital with symptoms, and, if the costs of taking and examining these smears is taken into account, the cost per clinical case treated nearly doubles to 835 pounds. Had outpatient and other follow-up costs been included, the difference in service costs would be even greater. Comparison of these figures assumes the controversial point that preclinical cancer will always progress to invasive carcinoma if left untreated and takes no account of inflation and discounting.

Meningeal carcinomatosis from a clinically undiagnosed signet-ring cell primary in the gallbladder

A patient with meningeal carcinomatosis is reported in whom the primary--which was not discovered clinically despite extensive investigation and cytological examination--proved to be the rare signet-ring cell tumor of the gallbladder. Determination of the nature and site of origin of the neoplastic cells in cytospin preparations of cerebrospinal fluid was complicated by the failure of conventional methods to stain cytoplasmic mucin. It is hoped that the application of monoclonal antibodies may resolve similar diagnostic problems in the future.