Persistent Carcinoma in Cervical Cancer Screening: Non-Participation Is the Most Significant Cause

Objective: It was the aim of this study to determine the screening history of all invasive cervical carcinomas between 2004 and 2009 in one of the Federal States of Germany. Study Design: The pooled data sets of all in-state laboratories, corrected and supplemented by data of the State Cancer Registry, were used. The screening histories of all patients, their age and tumor types were collated and analyzed. Results: Of 617 patients with invasive carcinoma of the cervix, 373 (60%) had not had a cervical smear within the past 5 years. In 188 patients (31%), an incomplete screening history was found, whereas only 9% of women had participated regularly. In non-participants, late tumor stages (stage T1B and higher) were predominant and found in 86%. In contrast, in the group with regular screening histories more than half of all cases (54%) were microinvasive carcinomas (stage T1A) with excellent prognosis. Lack of follow-up or refusal of treatment by patients played a minor yet significant role. Conclusions: Non-participation is still by far the most common reason for persistent cases of cervical carcinoma in the German screening program.