Invasive carcinoma of the cervix in young women

The cases of 194 women aged 40 years of age or less who had been diagnosed as having invasive cervical cancer in Queensland during 1972-1981 were reviewed retrospectively. Medical records contained a previous cervical cytological report for 89 women, with 18 of these having had a negative result of a smear test within two years of the diagnosis of invasive cancer. Cytological review of five of the 18 cases revealed neoplastic cells in three cases, and possible sampling inadequacies in the other two. Gynaecological symptoms had been present in seven of the 18 patients at the time of the negative result of cytological examination, and these persisted until the diagnosis was eventually made. A high index of suspicion is required when symptoms persist in spite of negative results of cytological examination and we recommend a review of the smear, a repeat smear examination with adequate sampling and referral for colposcopic examination in these circumstances.