Lawson study highlights misconceptions around screening, diagnosis of cervical cancer: researchers

HPV tests might be a better first-line test for cervical cancer than a Pap test, research says. Photodisc / Getty Images

A recent study by researchers at London’s Lawson Health Research Institute is shedding light on what they say are the common misconceptions around the screening and diagnosis of cervical cancer.

In the study, the researchers note that while deaths from cervical cancer have plummeted since regular screening protocols were implemented, some young women are finding themselves diagnosed with an advanced form of the cancer despite being screened.

For the study, Lawson researchers said they studied the records of women under 50 who had been treated for locally advanced cervical cancer, or LACC, between September 2010 and December 2012 at London Health Sciences Centre (LHSC) and who had undergone a Pap test within two years of their diagnosis.

The study said 13 out of 38 women had received a normal Pap test within this time period.

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In a statement, lead researcher Dr. David D’Souza said the findings suggested cervical cancer’s signs and symptoms are not always recognized by physicians, and that many believe LACC isn’t something that can occur in those who undergo regular screening.

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A Pap test, or Pap smear, is recommended every three years for women who see normal test results.

“The women we interviewed expressed feelings of shock upon receiving their diagnosis. They believed a normal Pap test meant they were cancer-free,” said D’Souza, also a radiation oncologist at LHSC.

According to researchers, the women taking part in the study said they would have lobbied their health-care provider for further management and investigations had they known cervical cancer was still possible even with routine screenings.

In addition, the researchers said their findings also pointed to a reluctance by health-care providers to perform detailed pelvic exams in the presence of symptoms.

The researchers pointed to several factors, including a lack of proper training for primary-care physicians, a reluctance to perform gynecologic exams on a young woman, and a lack of appreciation for the importance of a pelvic exam.

“There appears to be a lack of knowledge in patients and society in general with regards to HPV, screening and cervix cancer, with women believing that a Pap smear is considered an omnipotent test where those compliant need to know nothing more.”

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In a statement, LHSC gynecologist oncologist, Dr. Jacob McGee, said a Pap test should not be relied upon to rule out disease, calling it a screening tool, and not a diagnostic test for invasive cancer like LACC.

“[A] pelvic exam with direct visualization and assessment of the cervix should be an initial step in the evaluation of women who are symptomatic,” he said, adding there is also a need for greater awareness and education regarding the screening and vaccination of HPV.

The study said patients believed their delayed diagnosis led to a detrimental quality in their life, not just from the long-term effects of radiation and chemotherapy.

“Many expressed that despite being diagnosed with cancer and needing multimodality treatment with long-term changes in quality of life, they felt isolated and ignored citing a lack of support groups, fundraising efforts and awareness about their disease compared to other cancers such as breast cancer,” the study said.

“Providers and patients need to have an increased awareness of [cervical cancer] symptoms even when Pap screening has occurred,” the study concluded.

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