2012-11-10
Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: Population based cohort study
Publication
Publication
BMJ (Online) , Volume 345 - Issue 7882
Abstract
Objective To compare the risk of cervical cancer in women with
histologically confirmed cervical intraepithelial neoplasia who returned
to routine screening after having completed post-treatment follow-up
with consecutive normal smear test results with women with a normal
primary smear test result.
Design Population based cohort study using data from a nationwide
pathology register.
Setting The Netherlands, 1994 to 2006.
Population 38 956 women with histologically confirmed intraepithelial
neoplasia grades 1 to 3 with completed follow-up after treatment.
Intervention Routine post-treatment follow-up of cervical intraepithelial
neoplasia, recommending smear tests at six, 12, and 24 months.
Main outcome measure Incidence of cervical cancer in the period from
completed follow-up with negative test results after cervical intraepithelial
neoplasia to the next primary test. 10-year hazard ratios were compared
with periods after normal results for the primary smear test, adjusted for
year in follow-up.
Results 20 cervical cancers were diagnosed during 56 956 woman
years after completed follow-up of cervical intraepithelial neoplasia,
whereas 1613 cervical cancers were diagnosed during 25 020 697
woman years after a normal primary smear test result. The incidence of
35.1 (95% confidence interval 21.4 to 54.2) per 100 000 woman years
and 6.4 (6.1 to 6.8) per 100 000 woman years, respectively, led to an
adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for
periods after completed follow-up compared with periods after normal
primary smear test results. This hazard ratio was increased for all ages.
No significant difference in risk of cervical cancer was observed by grade
of cervical intraepithelial neoplasia.
Conclusions An excess risk of cervical cancer previously observed for
women treated for cervical intraepithelial neoplasia was also observed
in the subgroup of women who completed their post-treatment follow-up
with three consecutive normal smear test results. The overall corrected
risk of cervical cancer in these women was increased fourfold 35 cases
per 100 000 woman years) compared with women with normal primary
smear test results (6 per 100 000 woman years)
Additional Metadata | |
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doi.org/10.1136/bmj.e6855, hdl.handle.net/1765/70659 | |
BMJ (Online) | |
Organisation | Department of Gynaecology & Obstetrics |
Rebolj, M., Helmerhorst, T., Habbema, D., Looman, C., Boer, R., van Rosmalen, J., & van Ballegooijen, M. (2012). Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: Population based cohort study. BMJ (Online), 345(7882). doi:10.1136/bmj.e6855 |