The Cytology Program in British Columbia: Part III. Management of Preclinical Carcinoma of the Cervix

Between 1949 and 1961, 200,509 women were examined by routine cervical cytology in the Province of British Columbia. Cone biopsy is done when cytology is suspicious or positive, because the authors believe that proper management can be planned only after step serial sections of an adequate biopsy specimen. If the cone biopsy shows in situ carcinoma or microscopic foci of invasion, total hysterectomy is carried out in most cases. If occult but fully confluent invasion is present, radiotherapy is used. Of 1177 cases of preclinical carcinoma found in this study, 1051 were purely in situ carcinoma; 73 showed, in addition, microscopic foci of invasion; and 53 showed confluent active invasion but had not produced a clinical lesion. Mean age studies of the different groups of preclinical carcinoma support the contention that all are sequential stages of a single disease process. The only instances of recurrent invasive disease or mortality have been in the occult invasive group.