The diagnostic process of cervical cancer; areas of good practice, and windows of opportunity

A. Zaal, Marlieke de Wilde, M.J. Duk, G.C.M. Graziosi, Maarten van Haaften, S. von Mensdorff-Pouilly, Paul J. van Diest, RP Zweemer, Petra H.M. Peeters, RHM Verheijen

Research output: Contribution to journalLetterAcademicpeer-review



Despite an extensive screening programme in The Netherlands, some cases of cervical cancer are still diagnosed in late stages of disease. The aim of the present study was to investigate which elements in the diagnostic process of cervical cancer may be improved.


This is a retrospective study of 120 patients with cervical cancer diagnosed between January 1st 2008 and June 1st 2010 at the University Medical Center Utrecht. Patient charts, referral information, and pathology results were analyzed.


39.1% of cancer cases were screen or interval detected; the other 60.9% of patients had not been screened, either due to non-attendance or because they fell outside the age range for screening. The final diagnosis of cervical cancer was established by biopsy in 77 (64.2%) and by excision of the cervical transformation zone in 35 (29.2%) of the patients. Fifteen (43%) of these excisions could have been avoided if biopsies would have been taken at the first examination, and had shown invasive cancer.


Cervical cancer screening aims at early detection of precursor lesions to decrease the incidence of cancer. This in-depth analysis suggests that improvement of quality of care is to be expected from correct recognition of cervical cancer by physicians and adjustments of the screening programme to reach younger women and non-responders.
Original languageEnglish
Pages (from-to)405-410
JournalGynecologic Oncology
Issue number2
Publication statusPublished - Aug 2015


  • Uterine cervix
  • Cervical cancer
  • Colposcopy
  • Diagnosis
  • Quality of care
  • Screening


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