Incidence of cervical cancer after several negative smear results by age 50: Prospective observational study

Erasmus MC, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, Netherlands.
BMJ (online) (Impact Factor: 17.45). 04/2009; 338(apr24 1):b1354. DOI: 10.1136/bmj.b1354
Source: PubMed


To determine the incidence of cervical cancer after several negative cervical smear tests at different ages.
Prospective observational study of incidence of cervical cancer after the third consecutive negative result based on individual level data in a national registry of histopathology and cytopathology (PALGA).
Netherlands, national data. Population 218,847 women aged 45-54 and 445,382 aged 30-44 at the time of the third negative smear test.
10 year cumulative incidence of interval cervical cancer.
105 women developed cervical cancer within 2 595,964 woman years at risk after the third negative result at age 30-44 and 42 within 1,278,532 woman years at risk after age 45-54. During follow-up, both age groups had similar levels of screening. After 10 years of follow-up, the cumulative incidence rate of cervical cancer was similar: 41/100,000 (95% confidence interval 33 to 51) in the younger group and 36/100,000 (24 to 52) in the older group (P=0.48). The cumulative incidence rate of cervical intraepithelial neoplasia grade I+ was twice as high in the younger than in the older group (P<0.001).
The risk for cervical cancer after several negative smear results by age 50 is similar to the risk at younger ages. Even after several negative smear results, age is not a good discriminative factor for early cessation of cervical cancer screening.

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    • "For the three questions covered in this paper, we identified one RCT [20], two cohort studies [21,22] and 18 case–control studies (one study had four publications) [15-19,23-38]. Fourteen of these studies were used to examine the question of screening effectiveness, 14 studies (16 papers) provided data on screening intervals, and four studies (six papers) provided data that considered ages to initiate and discontinue screening. "
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    ABSTRACT: Background The systematic review on which this paper is based provided evidence for the Canadian Task Force on Preventive Health Care to update their guideline regarding screening for cervical cancer. In this article we highlight three questions covered in the full review that pertain to the effectiveness of screening for reducing cervical cancer mortality and incidence as well as optimal timing and frequency of screening. Methods We searched MEDLINE, Embase and Cochrane Central from 1995 to 2012 for relevant randomized controlled trials and observational studies with comparison groups. Eligible studies included women aged 15 to 70 years who were screened using conventional cytology, liquid-based cytology or human papillomavirus DNA tests. Relevance screening, data extraction, risk of bias analyses and quality assessments were performed in duplicate. We conducted a meta-analysis using a random-effects model on the one body of evidence that could be pooled. Results From the 15,145 screened citations, 27 papers (24 studies) were included; five older studies located in a United States Preventive Services Task Force review were also included. A randomized controlled trial in India showed even a single lifetime screening test significantly decreased the risk of mortality from and incidence of advanced cervical cancer compared to no screening (mortality: risk ratio 0.65, 95% confidence interval 0.47, 0.90; incidence: relative risk 0.56, 95% confidence interval 0.42, 0.75). Cytology screening was shown to be beneficial in a cohort study that found testing significantly reduced the risk of being diagnosed with invasive cervical cancer compared to no screening (risk ratio 0.38; 95% confidence interval 0.23, 0.63). Pooled evidence from a dozen case–control studies also indicated a significant protective effect of cytology screening (odds ratio 0.35; 95% confidence interval 0.30, 0.41). This review found no conclusive evidence for establishing optimal ages to start and stop cervical screening, or to determine how often to screen; however the available data suggests substantial protective effects for screening women 30 years and older and for intervals of up to five years. Conclusions The available evidence supports the conclusion that cervical screening does offer protective benefits and is associated with a reduction in the incidence of invasive cervical cancer and cervical cancer mortality.
    Full-text · Article · May 2013 · Systematic Reviews
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    • "Furthermore, in a recent study published from the Netherlands, the incidence of cervical cancer 10 years after having had three consecutive negative pap smears was similar for older women aged 45–55 (41/100,000, with 95% CI 33– 51) versus younger women, aged 30–44 years (36/100,000 with 95% CI 24–52), P = .48 [10]. Contrary to common belief that the incidence of cervical cancer would decrease with increased age, the incidence of cancer remained nearly the same, in this large national cohort of women. "
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    No preview · Article · Feb 2009 · BMJ (online)
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