Cervical carcinoma after negative pap smears: Evidence against rapid-onset cancers

Recently, suggestions have been made that a ‘rapid-onset’ type of cervical cancer is emerging. Evidence for this entity is based on the diagnosis of invasive cervical carcinoma within 2 or 3 years of a 'normal' Pap smear. Analysis of 237 patients presenting to our unit between November 1986 and July 1990 with the histologic diagnosis of invasive carcinoma of the cervix revealed 51 patients (21.5%) who reported having had a 'normal' Pap smear within 2 years of diagnosis. Strenuous efforts were made to verify and retrieve these smears in an attempt to isolate a group of 'rapid- onset' cancers. Despite the patients' claim to the contrary, there was no record of a smear being performed in 15 patients (29%). The slides of six patients could not be located either due to lack of laboratory co-operation or because the slides had been destroyed: four of these patients had very early adenocarcinomas. The slides of 30 patients were retrieved and reviewed: 16 slides reported as negative contained cells consistent with either invasive carcinoma or carcinoma in-situ; four cases had virtually no cellular material on the slide; four cases contained atypical cells but requests for further material were not followed-up. Six patients had previously been treated for pre-invasive lesions over a range of 3-18 years. We found no case of invasive carcinoma in a patient with a confirmed adequate negative smear within 2 years of diagnosis. At most, six patients (2.52%) could have had 'rapid-onset' cancers but this could not be confirmed as these slides could not be reviewed. In summary, this study suggests that in our patient population, 'rapid-onset' cervical carcinoma is rare.