Risk of invasive cervical cancer in relation to management of abnormal Pap smear results.
Silfverdal, Lena MD a; Kemetli, Levent MSci b; Andrae, Bengt MD c; Sparen, Par PhD d; Ryd, Walter MD, PhD e; Dillner, Joakim MD, PhD g; Strander, Bjorn MD, PhD f; Tornberg, Sven MD, PhD b
[Miscellaneous Article] American Journal of Obstetrics & Gynecology. 201(2):188e1-188e7, August 2009.

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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.

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