Clinical Health Updates

Postcoital bleeding of limited use in determining cervical cancer risk

Clinical Question:
Doc, I bleed after intercourse. Could I have cervical cancer?

Bottom Line:
The evidence base for management strategies of postcoital bleeding and calculations of risk for cervical cancer in women with postcoital bleeding are poor. Calculation of risk that a woman in the community developing postcoital bleeding has cervical cancer ranges from 1 in 44,000 at age 20-24 years to 1 in 2 400 aged 45-54 years.

Reference:
Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract 2006;56:453-460.

Study Design:
Systematic review

Synopsis:
These authors systematically reviewed several databases looking for English-language studies that reported or provided sufficient data to estimate the incidence or prevalence of postcoital bleeding. The authors don’t report looking for unpublished data, independent and paired application of inclusion criteria, or paired data abstraction. Ultimately, they included 38 articles. They found no studies that determined how often women presenting with postcoital bleeding subsequently have cervical cancer. One mass screening study from Finland identified 2648 women with postcoital bleeding of whom 12 (0.45%) had invasive cancer at the time of presentation. Eight of the articles (including hundreds of thousands of women), evaluated women in community settings. The overall rate of women complaining about postcoital bleeding is quite variable (0.7% to 9%); however, the large population-based studies report the prevalence at approximately 1%. It is not known how many of these women will seek medical care. Sixteen studies reported the prevalence of postcoital bleeding in more than 47,000 women with invasive cervical cancer. The range of prevalence in these studies was 0.7% to 39%.