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

doi:10.1136/bmj.b1354

Published 24 April 2009, doi:10.1136/bmj.b1354
Cite this as: BMJ 2009;338:b1354

Research

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

Matejka Rebolj, scientific researcher¹, Marjolein van Ballegooijen, associate professor of epidemiology¹, Elsebeth Lynge, professor of epidemiology², Caspar Looman, statistician¹, Marie-Louise Essink-Bot, associate professor of epidemiology¹, Rob Boer, professor of policy analysis¹, Dik Habbema, professor of medical decision sciences¹

¹ Erasmus MC, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, Netherlands, ² University of Copenhagen, Institute of Public Health, PO Box 2099, 1014 Copenhagen K, Denmark

Correspondence to: M Rebolj m.rebolj{at}pubhealth.ku.dk

Objective To determine the incidence of cervical cancer afterseveral negative cervical smear tests at different ages.

Design Prospective observational study of incidence of cervicalcancer after the third consecutive negative result based onindividual level data in a national registry of histopathologyand cytopathology (PALGA).

Setting Netherlands, national data.

Population 218 847 women aged 45-54 and 445 382 aged 30-44 atthe time of the third negative smear test.

Main outcome measures 10 year cumulative incidence of intervalcervical cancer.

Results 105 women developed cervical cancer within 2 595 964woman years at risk after the third negative result at age 30-44and 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 ofcervical cancer was similar: 41/100 000 (95% confidence interval33 to 51) in the younger group and 36/100 000 (24 to 52) inthe older group (P=0.48). The cumulative incidence rate of cervicalintraepithelial neoplasia grade I+ was twice as high in theyounger than in the older group (P<0.001).

Conclusions The risk for cervical cancer after several negativesmear results by age 50 is similar to the risk at younger ages.Even after several negative smear results, age is not a gooddiscriminative factor for early cessation of cervical cancerscreening.

© Rebolj et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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