Background In 2009, more than 11 000 women were diagnosed with invasive cervical cancer and approximately 4000 died. Many of these women were never screened or not screened in the 5 years before their diagnosis. Because vaccine uptake has been low, it is critical to continue efforts at early detection. We examined how many women diagnosed with cervical cancer at a public hospital were seen at the public STD clinic up to 5 years before diagnosis to detect missed opportunities for early detection.

Methods All cases with a diagnosis of cervical cancer from 1 January 1999 to 18 October 2010 were extracted from the electronic database of Wishard Hospital (Marion County Indiana's public hospital) using ICD-9 codes for severe squamous dysplasia (CIN3), adenocarcinoma in situ of the cervix and malignant neoplasm of cervix uteri. Results were validated using cytology and pathology records and women verified to have CIN3 or higher grade abnormalities were included. These were matched to patients in the electronic medical database of the Bell Flower Clinic (Marion County's public STD clinic) on the basis of first name, last name, date of birth, race and social security number when present. Missed opportunities were defined as those visits to Bell Flower within 5 years of a diagnosis of cervical cancer and no history of a PAP smear or HPV screening within 2 years at Wishard Hospital.

Results We identified 1309 women with cervical cancer diagnosed or treated at Wishard Hospital during the study period. Of these, 202 women were found to have visited Bell Flower at some time during the study period whereas 73 were found to have made 147 visits to Bell Flower Clinic <5 years prior to their diagnosis of CIN3 or higher. Because a substantial number of these women had normal or low grade abnormal PAPs at Wishard <2 years prior to their diagnosis, only 48 patients (97 visits) had visits that qualified as missed opportunities.

Conclusions Most women who developed cervical cancer diagnosed or treated at the public hospital had no record of a visit to the STD clinic. Of the 38 813 visits by women to Bell Flower during the study period, only 147 visits qualified as missed opportunities for detecting cervical cancer in 48 individuals. The number of women affected by missed opportunities was low, in part, because of accessible strong PAP smears at the public hospital.