Returning From Cancer To Normal

Cervical cancer cytology screening and hrHPV co-testing refined

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Having an abnormal pap smear in which "precancerous cervical lesions" show up is frightening for women. How these patients are followed may soon become less rigorous. Screening recommendations for women treated for precancerous cervical lesions have changed.

After three consecutive normal pap smears, a woman who has been treated for precancerous lesions has the same 5-year risk of developing full-blown cervical cancer as the general population. Those are the findings of a recently published Dutch study.

"Ask your doctor when you should be screened for cervical cancer."

Even after treatment, roughly 15 percent of women diagnosed with high-grade intraepithelial neoplasia (CIN grade 2 or 3) will eventually have the cancer return.

There has not been a consensus about recommendations for long-term follow-up surveillance for this group. Currently, women undergo traditional cytology (Pap smears) and high-risk human papillomavirus (hrHPV) testing on an ongoing basis.

This study was designed to examine the effectiveness of follow-up screening for identifying women at long-term risk of recurrent CIN and whether different strategies could be used to reduce the number of screenings.

Chris Meijer from VU University Medical Center in Amsterdam and Theo Helmerhorst from the Erasmus University, Rotterdam, led a team of Dutch colleagues. They followed 435 women who had received treatment for CIN 2 or 3 between July 1988 and November 2004.

Cytology screening and hrHPV co-testing were performed at 6, 12, and 24 months after treatment and then by population-based screening every 5 years.

The overall 5-year risk of developing recurrent CIN 2 or higher was 16.5 percent for the entire group.

However, in women who had three consecutive normal smears or negative hrHPV co-testing results, that risk was reduced to less than 3 percent - which is similar to the risk seen in the general population.

The study also confirmed the benefit of adding hrHPV testing to post-treatment surveillance. Testing at 12 months wasn't necessary in women who are negative by co-testing at 6 months.

The authors caution that women who have abnormal test results need to follow a more rigorous screening regimen since they are at substantial risk of developing cervical cancer within the next 5 years.

The findings were published in The Lancet Oncology.

Reviewed by: 
Review Date: 
June 21, 2011
Last Updated:
June 24, 2011