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

Am J Obstet Gynecol. 2009 Aug;201(2):188.e1-7. doi: 10.1016/j.ajog.2009.04.006. Epub 2009 Jun 26.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / pathology*
  • Case-Control Studies
  • Female
  • Humans
  • Middle Aged
  • Odds Ratio
  • Papanicolaou Test*
  • Registries
  • Risk Factors
  • Sweden / epidemiology
  • Uterine Cervical Neoplasms / epidemiology*
  • Uterine Cervical Neoplasms / pathology*
  • Vaginal Smears / statistics & numerical data*