Audit of deaths from cervical cancer: Proposal for an essential component of the National Screening Programme

Abstract

Aims - To ascertain the type and relative frequency of major factors associated with deaths from cervical cancer. Methods - Deaths from cervical cancer in Rotherham district for the period 1989-1991 were subjected to multifactorial audit by reviewing laboratory, hospital, and general practitioner records; together with, when appropriate, re-screening of cytology smears. This period represented the three to five years after a computerised National Screening Programme (NSP) had been implemented with a five year recall interval. Results - Thirty six deaths were identified. The average age of death was 59 years with 39% occurring in those over 65. Only 6% of cases presented as a result of a cervical smear, comprising 3% derived from the NSP and 3% by chance. Forty seven per cent of cases in which the patient had died had no record of a previous smear invitation; 22% of patients were under 65 years and 25% 65 or over. Those under 65 had presented before the appropriate age band had been called. A non-response to a cervical smear invitation was identified in 22%. In 25% of cases a true negative smear had been reported one to eight years previously (average 4.8 years). An inappropriate laboratory diagnosis was identified in 17% of cases. Fourteen per cent represented false negative smears and 8% comprised inadequate smears that had been reported as negative. Inappropriate clinical diagnosis or management was identified in 19% of cases. In 22% two or more contributory factors were identified in the same patient. Conclusions - Areas highlighted by the audit warranting further attention included the targeting of women over 65 with no cytology record; those not responding to smear invitations; laboratory performance; clinical acumen; and the reasons for true negative cervical smears. Multifactorial audit of all deaths from cervical cancer should be advocated nationally to assess and improve the effectiveness of the NSP.