PART TWO
Diagnostic Cytology
Fig. 8.98 Atrophy in postmenopause. Cells with an increased
nucleocytoplasmic ratio against a background of cellular debris and
inflammatory cells (Papanicolaou x OI).
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Fig. 8.99 Atrophy in postmenopause. Aggregate of cells with indistinct
cell borders, increased nucleocytoplasmic ratio, variation in nuclear size and
shape, and hyperchromasia (Papanicolaou x HP).
resulting in a clear background against which truly abnormal
cells usually stand out clearly.
Invasive Cancer of the Uterine Cervix
Epidemiology
Worldwide, cancer of the cervix is the second most common
cancer in women. In developing countries, this type of cancer
even ranks first, whereas in developed countries it ranks tenth.
In most developed countries, the frequency of cervical cancer
and the mortality rate for cervical cancer have declined since the
1950s. Cervical smears are important in the prevention of cancer
of the cervix.118,182-184 The first priority is to screen the group that
has never been examined. An increase in the number of screen-
ings by reducing the interval between screenings is reported to
have only a marginal benefit.
Fig. 8.100 Effect of a short course of estrogenic hormones. Maturation
of squamous cells. Some minimal atypia of parabasal cell type remaining. No
evidence of an epithelial abnormality (same case as that in Fig. 8.91)
(Papanicolaou x HP).
Fig. 8.101 Effect of a short course of estrogenic hormones. Maturation
of squamous cells and some highly atypical squamous cells with increased
nucleocytoplasmic ratio, irregular nuclei, and dense hyperchromatic nuclei.
Abnormal cells are consistent with severe dysplasia (same case as that in Fig.
8.92) (Papanicolaou x OI).
Olesen analyzed the number of previous smears in 428
women who developed invasive cancer of the cervix and com-
pared these with previous screenings in age- and area-matched
controls.185 He reported that 55% of the patients with cancer
and 33% of the controls had never been screened before. This
was a highly significant difference. Regular screening reduced
the relative risk for invasive cancer in the screened population
to about 0.25. When only symptomless patients were analyzed,
the relative risk was reduced to 0.15. Even the group of patients
screened more than 5 years previously had a reduction in rela-
tive risk for developing invasive cancer to 0.67. The incidence of
invasive cancer in the age group participating in the Nijmegen
screening program dropped significantly 3 years after the start
of the program. After two negative smears, in only 0.01% of the
screened women was a severe epithelial abnormality detected.76
184
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