Women who have been treated for precancerous cervical lesions face a similar 5-year risk of developing cervical cancer or recurrent disease to women in the general population after three consecutive normal cytological smears (Pap tests), and can return to population-based regular screening. The findings, published Online First in The Lancet Oncology, confirm that the current post-treatment surveillance strategy (three cytological smears) is effective for identifying women at long-term risk of cervical cancer.
Despite undergoing treatment, about 15% of women diagnosed with high-grade cervical intraepithelial neoplasia (CIN grade 2 or 3) will develop recurrent disease. Among the surveillance options available to women who have been previously treated for the disease are conventional cytology and high-risk human papillomavirus (hrHPV) testing, which has reported a high negative predictive value in the first 2 years after treatment. But information on the long-term performance of follow-up testing in this high-risk population is lacking and current recommendations about long-term follow-up vary widely.
In this study, Chris Meijer from VU University Medical Center in Amsterdam and Theo Helmerhorst from the Erasmus University, Rotterdam, led a team of Dutch colleagues to examine the effectiveness of follow-up screening for identifying women at long-term risk of subsequent CIN and whether different strategies (such as co-testing—combining cytology with hrHPV testing) could reduce the number of screens needed after treatment. The study included 435 women who were treated for CIN 2 or 3 between July 1988 and November 2004 and were monitored by cytology and hrHPV co-testing at 6, 12, and 24 months after treatment, and then by population-based screening every 5 years.
The 5-year risk of developing post-treatment CIN 2 or higher was 16.5%. This risk was reduced to less than 3% in women who had three consecutive cytological normal smears or negative co-testing—a similar risk to women with normal cytology in the general population.
Findings also showed that by adding hrHPV testing to post-treatment surveillance, testing at 12 months could be omitted in women who are negative by co-testing at 6 months.
The authors say: "The 5-year risks of post-treatment disease in these women are such that they do not need to be followed up more closely than women in population-based screening (every 5 years)…and could therefore return to [regular screening]."
However, they conclude that more intensive surveillance is vital in women at a higher risk of recurrence: "Women who do not have negative screening algorithms post-treatment…should receive additional testing or colposcopic examination, or both", because they have a substantial risk of developing post-treatment disease within the next 5 years.
Professor Chris Meijer, VU University Medical Center, Amsterdam, Netherlands. E) cjlm.meijer@vumc.nl
Or via Caroline Arps, Communications Department, VU University Medical Center T) +31 20 444 3444
Journal
The Lancet