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Risk of cervical cancer associated with extending the interval between cervical-cancer screenings
George F Sawaya1, K John McConnell, Shalini L Kulasingam
1Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Veterans Affairs and University of California, San Francisco, San Francisco, USA.
The New England Journal of Medicine
|October 17, 2003
Summary
Extending Papanicolaou (Pap) tests to three years for low-risk women with prior negative results slightly increases cervical cancer risk. The excess risk of cervical cancer is approximately 3 in 100,000 with less frequent screening.
Area of Science:
- Gynecology
- Oncology
- Preventive Medicine
Background:
- Current guidelines allow extending Papanicolaou (Pap) tests to three-year intervals for low-risk women with prior negative results.
- The precise excess risk of cervical cancer with less frequent screening remains uncertain.
Purpose of the Study:
- To determine the prevalence of cervical neoplasia in relation to Papanicolaou test history.
- To estimate the excess risk of cervical cancer associated with extended screening intervals.
Main Methods:
- Analysis of biopsy-proven cervical neoplasia prevalence in 938,576 women younger than 65.
- Utilized a Markov model to estimate cancer progression rates and risks.
- Calculated additional tests and colposcopies needed to prevent one cancer case.
Main Results:
- Among women 30-64 with three negative Pap tests, prevalence of high-grade cervical intraepithelial neoplasia was low (0.028% grade 2, 0.019% grade 3).
- Estimated cancer risk over three years: 2-5/100,000 (annual screening) vs. 1-5/100,000 (3-year interval).
- Preventing one cancer case required 69,665-209,324 additional Pap tests and 3,861-11,502 colposcopies.
Conclusions:
- Screening once every three years, compared to annual screening, is associated with an average excess cervical cancer risk of approximately 3 in 100,000 for women 30-64 with prior negative Pap tests.
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