Having worked at the racetrack
through college, 37-year-old Mona L likes to think she
knows where to place her bets. She's endured annual Papanicolaou
(Pap) smears for years in the hope that early detection
of cancerous cells, and the resulting jump-start on treatment,
would strengthen the odds of surviving cervical cancer.
With her last Pap smear coming back abnormal, Mona certainly
hopes that this classical wisdom prevails. However, a
Finnish study in the December 20 issue of the International
Journal of Cancer suggested that early cancer detection
may not mean the outcome is a sure bet.
While "preinvasive lesions of the
cervix uteri are regarded as a curable disease despite
some progression to invasive cancer ... the ultimate
outcome is not known," wrote the authors, led by Dr
Tapio Luostarinen of the Finnish Cancer Registry in
Helsinki.
TENETS
IN TENUOUS SPOT
The study, which estimated the 45-year survival of 12,655
Finnish women who had been diagnosed with in situ
cancer of cervical cells of the uterus, indicated
that the hitherto rosy prognosis following the early
detection of preinvasive cells is "not necessarily true,"
at least for women who are diagnosed later in life.
The women in the study had been
diagnosed with carcinoma in situ lesions between
the years 1953 and 2000, and their cases had been reported
to the Finnish Cancer Registry. "Up to 30 years of followup
there was about [a] 1% decrease in cumulative relative
survival per five years of followup. After that the
excess mortality increased and the survival at 45 years
was 84%," wrote Dr Luostarinen and colleagues.
THE
YOUNG DO BETTER
The age of the women also factored into their longer
term outlook. In women who were under 35 at the time
of their diagnosis, the 15-year survival was as good
as it could get, at 100%. But, for older folks who were
aged 60 to 74 at the time of diagnosis, the survival
rate was markedly less, at 89%.
The bottom line of the study is
that early detection of cervical cancer and swift aggressive
treatment may not necessarily be successful. The high
risk of death apparent in the longterm study "is likely
to indicate that patients with carcinoma in situ
are not completely cured," concluded the Finnish researchers.
This is frightening news given
that cervical cancer is the third most common cancer
type for women aged 20 to 49. Overall it's the 10th
most frequent type of cancer afflicting Canadian women,
according to Health Canada.
Int J Cancer 2004 Dec 20;112(6):1072-4
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