Initial Effect of Community-Wide Cytologic Screening on Clinical Stage of Cervical Cancer Detected in an Entire Community. Results of Memphis-Shelby County, Tennessee, Study2

Abstract

Cytologic technique was applied to vaginal aspiration smears taken from 151,000 women, including 67.6 percent of the white and 57.3 percent of the Negro population of Memphis and Shelby County, Tennessee, 20 years of age and older. At first screening performed during the 5 years beginning July, 1952, 1.3 cases of unsuspected invasive cervical cancer were detected in each 1,000 white residents screened, and 1.8 cases per 1,000 Negro residents. The prevalence ratios for unsuspected intra-epithelial carcinoma (carcinoma in situ) detected were 3.1 per 1,000 white residents and 4.0 per 1,000 Negroes. The prevalence of unsuspected invasive disease, taken in connection with the presurvey yearly incidence of newly diagnosed cases, provided an estimate that the cytologically detected cases were probably identified, on the average, about 3 years earlier in their invasive phase than the cases diagnosed in the presurvey period. Benefit of the program to the community is indicated by diagnosis of invasive disease at an earlier stage in the entire population. Prior to the screening program, 34 percent of all white patients and 18 percent of all Negro patients in Memphis and Shelby County were in clinical stage I at diagnosis. During the program these proportions increased to 57 and 38 percent, respectively, for the entire population, and to 86 and 77 percent, respectively, for unsuspected cancer cases detected by the screening technique.