Case Report Delay in treatment of invasive cervical cancer due to intimate partner violence Martin A. Martino * , Arjun Balar, Janiel M. Cragun, Mitchel S. Hoffman Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida, H. Lee. Moffitt Cancer Center, Department of Gynecologic Oncology, 12902 Magnolia Drive, Tampa, FL 33612, USA Received 15 March 2005 Available online 26 July 2005 Abstract Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs. D 2005 Elsevier Inc. All rights reserved. Keywords: Cervical cancer; Intimate partner violence; Domestic abuse; Delay; Diagnosis; Treatment Introduction Intimate partner violence (IPV) can be defined in physical as well as psychological terms. The term would include ‘‘psychological and emotional abuse, controlling behaviors, threats, physical and sexual abuse’’ [1]. The effect of IPV, either physical or psychological, on long- term health is not defined. Although models developed from population screening have implicated IPV as a contributor to many long-term illnesses, to date, it has not been directly linked to delayed diagnosis or treatment of cancer [2]. An accepted modality of IPV involves both abuse of power and control of the victim. Many studies suggest a regular usage of primary care services by IPV victims [3]. However, their access to follow-up treatment and compliance to treatment plans are less well defined. We present a case report describing the progression of invasive cervical cancer in a victim who delayed her treatment. While this is the first reported case in the literature describing a delay in cancer treatment secondary to domestic abuse, we believe such occurrences are regretfully an underreported event. Case report A 41-year-old G4P4 Caucasian female was initially diagnosed in early 1999 after colposcopic biopsy with high-grade cervical dysplasia (CIN-III) and was scheduled to undergo either a cone biopsy or loop electrosurgical excision procedure (LEEP), but declined either procedure, despite extensive counseling. In the fall of 2001, she re- presented with excessive and irregular bleeding. A colpo- scopic biopsy again showed severe dysplasia (CIN III). Additional medical history was significant for smoking 2 packs per day for 28 years. A cold knife cone procedure was performed in January of 2002. Pathology revealed a poorly differentiated invasive 0090-8258/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2005.06.034 * Corresponding author. Fax: +1 813 979 7228. E-mail address: Martinma@moffitt.usf.edu (M.A. Martino). Gynecologic Oncology 99 (2005) 507 – 509 www.elsevier.com/locate/ygyno