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Multicenter Study
. 2009 Apr 24:338:b1354.
doi: 10.1136/bmj.b1354.

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

Matejka Rebolj  1 , Marjolein van Ballegooijen, Elsebeth Lynge, Caspar Looman, Marie-Louise Essink-Bot, Rob Boer, Dik Habbema
Affiliations
Multicenter Study

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

Matejka Rebolj et al. BMJ. .

Abstract

Objective: To determine the incidence of cervical cancer after several negative cervical smear tests at different ages.

Design: 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).

Setting: 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.

Main outcome measures: 10 year cumulative incidence of interval cervical cancer.

Results: 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).

Conclusions: 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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Conflict of interest statement

Competing interests: The department of public health of the Erasmus MC received a grant from GSK, a manufacturer of an HPV vaccine, for research on the cost effectiveness of HPV vaccination in 2007 and 2008. This research and manuscript were neither funded nor supported by GSK. RB has been participating since 1989 in the screening research group at the department. He has been affiliated with RAND since 2000. Since 2007, he has been a director of evidence based strategies-disease modelling and economic evaluation at Pfizer, who develop and sell various drugs for cancer and other diseases. This research and manuscript were neither funded nor supported by Pfizer.

Figures

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Fig 1 Schematic presentation of study. Consecutive primary smears counted throughout entire period covered by PALGA system (from late 1970s onwards), whereas person years at risk and cases counted from 1 January 1994 to 31 December 2002. Person years and cases accrued before 1 January 1994 excluded from analysis (left censoring)
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Fig 2 Cumulative incidence rate for invasive cancer by age group and time since third consecutive negative smear result
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Fig 3 Cumulative incidence rate for cervical intraepithelial neoplasia grade I+ (CIN I+) by age group and time since third consecutive negative smear result
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