Variations in the screening history and appropriateness of management of cervical cancer in South East England.

In seven health districts in southern England, an audit of the management of cervical cancer compared with regionally developed guidelines was undertaken between 1988 and 1991. Four hundred and sixty-nine regional residents were treated in the study district hospitals. 73 (15.6%) women were appropriately staged, with increasing likelihood of appropriate staging investigations observed with higher stages (P < 0.0001) and type of hospital [Teaching 23 (21%), Non-Teaching with oncology support 11 (11.5%), Non-teaching 4 (7%), P < 0.0001] but with no change over the study period. There was no significant trend in the proportion of women treated appropriately over time, with 270 (59%) being appropriately treated, 91 (20%) under-treated and 98 (21%) over-treated overall. Appropriateness of treatment increased with higher stages (P < 0.0001) and hospital workload for cancer of the cervix (P = 0.038). Multivariable analysis indicated that survival independently and significantly decreased with age and stage, under-treatment and in cases where lymph nodes were involved or not examined. There was no change in the appropriateness of management over the 4 years, with high levels of inappropriate care. Survival was not only influenced by biological and demographic factors, but by inappropriate care.