Good news for women treated for precancerous cervical lesions. A Dutch study published in Lancet Oncology shows that after three consecutive normal cytological smears (Pap tests) women face a similar 5-year risk of developing cervical cancer or recurrent disease to the general population and can return to population-based regular screening.

Despite treatment around 15% of women treated for high grade cervical intraepithelial neoplasia (CIN grade 2 or 3) develop recurrent disease, most of which is diagnosed within two years of treatment. To gain greater insights into the effectiveness of long term screening strategies for identifying women at high risk of subsequent CIN, Chris Meijer and colleagues, from Erasmus University Medical Center (The Netherlands), assessed the long-term cumulative risk of post-treatment CIN grade 2 or 3 or cancer.

In the analysis 435 women treated for CIN grade 2 or 3 between July 1988 and November 2004 were followed up by cytology and human papillomavirus testing at 6, 12, and 24 months after treatment. If clear they subsequently received cytological screening every 5 years.

The results showed that the five year risk of developing post-treatment CIN grade 2 or higher was 16.5% and that the 10 year risk was 18.3%. However, for women who had three consecutive negative cytological smears the five year risk of developing post-treatment CIN grade 2 or higher was 2.9%, and the 10 year risk was 5.2%.

“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,” write the authors. However, they add that more intensive surveillance is vital for women who do not have negative screening results post treatment, and that these women should receive additional testing or colposcopic examination or both.

Reference

M Kocken, T JM Helmerhorst, J Berkhof et al Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study The Lancet Oncology Doi:10.1016/S1470-2045(11)70078-X