Strategy Found Effective for Women With Cervical Neoplasia

After three normal pap smears, affected women at similar risk for cervical cancer as general population

THURSDAY, April 28 (HealthDay News) -- Women with a history of high-grade cervical intraepithelial neoplasia (CIN grade 2 or 3) who have had three consecutive negative cytological smears are at a similar five-year risk of developing cervical cancer or recurrent disease as women in the general population, according to a study published online April 28 in The Lancet Oncology.

Marielle Kocken, M.D., of the Erasmus MC University Medical Center in Rotterdam, Netherlands, and colleagues followed 435 women who were included in three studies in the Netherlands and were treated for CIN grade 2 or 3 between July 1988 and November 2004. The women were followed up with cytology and testing for high-risk human papillomavirus (hrHPV) at six, 12, and 24 months after treatment, and then received cytological screening every five years.

The investigators found that the five-year risk of developing post-treatment CIN 2 or higher was 16.5 percent and the 10-year risk was 18.3 percent. In addition, the five-year risk of developing post-treatment CIN grade 3 or higher was 8.6 percent and the 10-year risk was 9.2 percent. The investigators also found that women with three consecutive negative cytological smears had a five-year risk of developing CIN grade 2 or higher of 2.9 percent -- a similar risk to women with normal cytology in the general population -- and a 10-year risk of 5.2 percent. The investigators showed that testing at 12 months could be omitted in women who were negative by testing with cytology and hrHPV at six months.

"In conclusion, women who have three consecutive negative cytological tests can be referred to population-based screening because their five-year risk of developing CIN grade 2 or higher is less than 3 percent. By adding hrHPV testing to post-treatment surveillance, testing after 12 months can be omitted in women negative for co-testing [testing with cytology and hrHPV] at six months," the authors write.

Two authors disclosed financial ties to pharmaceutical companies.

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