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Simple Hysterectomy for Cervical Cancer

Risk Factors for Failed Screening and Deviation From Screening Guidelines

Castellano, Tara, MD; Ding, Kai, PhD; Moore, Kathleen N., MD; Landrum, Lisa M., PhD, MD

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 124–128
doi: 10.1097/LGT.0000000000000463
HPV-Associated Disease: Diagnosis and Management

Objective The aim of this study is to describe risk factors associated with either false-negative cervical cancer screening or deviations from screening guidelines that result in incidentally found invasive cervical cancer at the time of simple hysterectomy for benign indications.

Materials and Methods This is a retrospective review from 1990 to 2017 of subjects with incidental cervical cancer. Baseline demographics, preoperative evaluations, surgical data, and histopathologic characteristics were recorded. Deviations from screening guidelines or false-negative screenings were identified. Associations of independent risk factors according to age, insurance status, and histology were assessed.

Results Fifty-nine subjects with a median age of 43 years were found. Abnormal uterine bleeding was the most common indication for hysterectomy (61%, n = 36) and cervical dysplasia was present in 42% (n = 25) of these cases. Of those with inappropriate screening, 38% (n = 17) did not have documented Pap test, 22% (n = 10) had Pap that was not triaged appropriately, 18% (n = 8) received Pap and colposcopy but no indicated excisional procedure, and 22% (n = 10) had an excisional procedure that was not managed according to guidelines. False-negative screening occurred in 25% subjects (n = 15). There was no significant association between age, insurance status, or histology and risk of false-negative screening or inadequate screening.

Conclusions The most common cause of incidental cervical cancer at the time of simple hysterectomy was failure to properly adhere to screening guidelines. Less frequently, false-negative screening was the cause. No independent risk factor in either group was identified in this single institutional study. Illustrated is the importance of continuing education of surgeons about adequate screening in the preoperative evaluation for benign hysterectomy.

University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK

Reprint requests to: Tara Castellano, MD, 8000 NE 10th St, Suite 5050, Oklahoma City, OK 73104. E-mail:

K.M. reports advisory board participation for Astra Zeneca, Advaxis, Clovis, Genentech/Roche, Immunogen, Tesaro, VBL Therapeutics, and Janssen. She serves as the International Chair for the IMagyn 050 trial (Genentech/Roche). The other authors have declared they have no conflicts of interest.

The study was approved by University of Oklahoma Institutional Review Board (IRB#: 8445; approval date: January 26, 2018–December 31, 2018).

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology