Risk of invasive cervical cancer in relation to management of abnormal Pap smear results

Received 1 October 2008; received in revised form 24 January 2009; accepted 10 April 2009. published online 29 June 2009.

Objective

We sought to evaluate the management of women with abnormal cytology in terms of subsequent risk of invasive cervical cancer.

Study Design

The screening histories of all invasive cervical cancer cases diagnosed in Sweden 1999-2001 and of 5 population-based controls per case were reviewed. In all, 159 patients and 258 control subjects aged < 67 years had an abnormal smear result 0.5-6.5 years prior to cancer diagnosis. The cervical cancer risk was estimated in relation to management by calculating odds ratios.

Results

Histologic assessment of low-grade squamous abnormalities strongly reduced the risk compared to repeated cytology (odds ratio, 0.46; 95% confidence interval, 0.24-0.89). Delaying histologic assessment was also associated with a higher risk (odds ratio, 5.65; 95% confidence interval, 1.39-23.05). After high-grade squamous atypia, absence of any cytologic or histologic specimen was a major determinant of cancer risk (odds ratio, 12.52; 95% confidence interval, 1.42-infinitive).

Conclusion

For adequate protection against invasive cervical cancer, further assessment with histology must be recommended also for women with low-grade squamous abnormalities.

Key words: cervical cancer risk, histologic assessment, management of abnormal Pap smear results, population-based case control study, repeated cytology

a Department of Obstetrics and Gynecology, Umeå University Hospital, Umeå, Sweden

b Cancer Screening Unit, Oncologic Center, Karolinska University Hospital, Stockholm, Sweden

c Department of Obstetrics and Gynecology, Gävle Hospital, Gävle, Sweden

d Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

e Department of Pathology and Clinical Cytology, Sahlgrenska University Hospital, Göteborg, Sweden

f Oncologic Center, Sahlgrenska University Hospital, Göteborg, Sweden

g Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö, Sweden

Funded by the Swedish Cancer Society.

Reprints not available from the authors.

Cite this article as: Silfverdal L, Kemetli L, Andrae B, et al. Risk of invasive cervical cancer in relation to management of abnormal Pap smear results. Am J Obstet Gynecol 2009;201:188.e1-7.

PII: S0002-9378(09)00392-5

doi:10.1016/j.ajog.2009.04.006

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