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Estimated Cancer Risk in Females Who Meet the Criteria to Exit Cervical Cancer Screening
Shalini L Kulasingam1, Inge M C M de Kok2, Abhinav Mehta1
1Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
JAMA Network Open
|March 12, 2025
Summary
Women exiting cervical screening after negative cotests have a low risk of cervical cancer, but this risk increases with age. Future guidelines should consider these evolving risks when setting screening exit criteria.
Area of Science:
- Gynecology
- Oncology
- Epidemiology
Background:
- US guidelines allow cervical cancer screening cessation at 65 after two negative cotests (HPV and cytology).
- Limited data exist on cancer and mortality risks for women who stop screening based on these criteria.
Purpose of the Study:
- To estimate the risks of cervical cancer and associated mortality in women meeting US cotesting exit criteria.
Main Methods:
- Four validated decision-analytic models from the Cancer Intervention and Surveillance Modeling Network-Cervical consortium were used.
- Models were validated against Kaiser Permanente Northern California data for cervical intraepithelial neoplasia grade 3 (CIN3) risks.
Main Results:
- All models projected 5-year CIN3 risks within empirical ranges.
- Cervical cancer and death risks increased with age and time since screening cessation.
- By age 85, cumulative risks ranged from 0.026%–0.081% for cancer and 0.005%–0.038% for death.
Conclusions:
- Women meeting US cotesting exit criteria have low estimated risks of cervical cancer and death.
- These risks, however, increase over time and with age, suggesting a need for nuanced guideline considerations.
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