Potential Effects of Updated Pap Test Screening Guidelines and Adenocarcinoma In Situ of the Cervix

Barroilhet, Lisa MD; Van Hanegem, Lennie MD; Bernstein, Marilyn MHP; Feldman, Sarah MD, MPH

doi: 10.1097/AOG.0b013e3182887cad
Original Research

OBJECTIVE: To review cases of adenocarcinoma in situ (AIS) at our institution to examine how updated guidelines affect the timing of diagnosis.

METHODS: We identified patients with AIS diagnosed between 1998 and 2010 using the International Classification of Diseases, 9th Revision, Clinical Modification, code 233.1. Diagnosis was confirmed by pathology review. We abstracted demographic data, dysplasia history, and modalities utilized for diagnosis and treatment.

RESULTS: We identified 242 patients who met selection criteria. Two hundred eight (86%) had Pap test abnormalities at presentation. One hundred thirty-seven out of 208 (66%) patients with abnormal Pap test results had a squamous, rather than glandular, abnormality. The mean time from abnormal Pap test to diagnosis of AIS was 29 months in patients older than 30 years and was 21 months in patients 30 years or younger. In patients younger than 21 years, 16 out of 17 had abnormal screening Pap test results showing squamous lesions. Their subsequent treatment for squamous dysplasia ultimately led to the diagnosis of AIS.

CONCLUSION: Updated screening guidelines may prevent the expeditious diagnosis of AIS in females younger than 21 years and those aged 21–29 years, many of whom had normal Pap test results within 3 years of diagnosis.

LEVEL OF EVIDENCE: II

Updated Pap test screening guidelines may result in delayed or missed diagnosis of adenocarcinoma in situ, particularly in women younger than 30 years.

University of Wisconsin, Madison, Wisconsin; Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts; and Academisch Medisch Centrum, University of Amsterdam, Amsterdam, the Netherlands.

Corresponding author: Lisa Barroilhet, MD, UW Hospital, H4/658 CSC, 600 Highland Avenue, Madison,WI 53792; e-mail: barroilhet@wisc.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists