1. Cytologic Findings in Type 2 Cervical Carcinomas: Some Cervical Carcinomas are more Difficult to Prevent with Screening R. Marshall Austin MD,PhD Magee-Womens Hospital of University of Pittsburgh Medical Center

2. Two Types of Cervical Carcinoma Type I Cervical Cancers (Slow-Growing) Type II Cervical Cancers Limited Superficial Invasive Cancer Subsurface Invasive Cancer may remain asymptomatic until cervical rupture EXTENSIVE CIN3 LIMITED, NONDIAGNOSTIC, OR HIDDEN CIN3/AIS

3. Agency for Healthcare Policy and Research Evidence Report/Technology Assessment Number 5 Evaluation of Cervical Cytology (1999)

4. Cervical Cancer Cases per 100,000 women screened ages 15-85 ( “Evaluation of Cervical Cytology” 1999 ) No PapQ3 yr screens Q2 yr screens Q1 yr screens Pap Smear 3015 506 305 109 ↓40% FN 322 181 55 ↓60% FN 246 132 33 ↓90% FN 161 79 9

5. Case #1: Aggressive Squamous Carcinoma in a Young Woman 10 yrs before SCC dx: Pap “Benign cellular changes” 9 yrs before SCC dx: Pap “Inflammatory changes” Class I 7 yrs before SCC dx: WNL atrophy 6 yrs before SCC dx: WNL atrophy 3 yrs before SCC dx: Negative

6. Pap 14 months before SCC diagnosis

12. Cervical Biopsy- Age 26 Bloody discharge Beefy red abnormal-appearing cervix, clinically suspicious for cancer

13. Cervical Biopsy- Age 26

17. Stage 1B cervical squamous cell carcinoma diagnosed at age 26, 3 ½ yrs later free of disease Hysterectomy Chemoradiation

18. Case#1: Issues Likelihood of symptoms in Stage I cervical carcinoma is only around 15%. Less cellular abnormal Pap smears are more likely to result in false negative screening test results. Smaller CIN3 lesions will shed fewer abnormal cells.

19. Two Types of Cervical Carcinoma Type I Cervical Cancers (Slow-Growing) Type II Cervical Cancers Limited Superficial Invasive Cancer Subsurface Invasive Cancer may remain asymptomatic until cervical rupture EXTENSIVE CIN3 LIMITED, NONDIAGNOSTIC, OR HIDDEN CIN3/AIS