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Frequency and Outcome of Cervical Cancer Prevention Failures in the United States

Stephen S. Raab MD, Dana Marie Grzybicki MD, PhD, Richard J. Zarbo MD, DMD, Chris Jensen MD, Stanley J. Geyer MD, Janine E. Janosky PhD, Frederick A. Meier MD, Colleen M. Vrbin, Gloria Carter MD, Kim R. Geisinger MD
DOI: http://dx.doi.org/10.1309/97JHG6GLY69BVF4Y 817-824 First published online: 1 November 2007


We measured the frequency and outcome of cervical cancer prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous cancers (1 in 187,786 Pap tests), glandular cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that cervical cancer prevention practices are remarkably successful in preventing squamous cancers, although a high frequency of failures results in low-impact negative outcomes.

Key Words:
  • Papanicolaou test
  • Cervical cancer
  • Patient safety
  • Colposcopy