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

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

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

Cervical Cancer Cases per 100,000 women screened ages ( “Evaluation of Cervical Cytology” 1999 ) No PapQ3 yr screens Q2 yr screens Q1 yr screens Pap Smear ↓40% FN ↓60% FN ↓90% FN

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

Pap 14 months before SCC diagnosis

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

Cervical Biopsy- Age 26

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

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.

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