Risk of CIN2 in women with a pap test without endocervical cells vs. those with a negative pap test with endocervical cells: a cohort study with 4.5 years of follow-up.
OBJECTIVE
To measure the risk of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in the 4.5 years following a negative Pap smear with adequate endocervical cells (ECC) (+) or absent/scarce ECC (-).


METHODS
A prospective, nonconcurrent study of the archives of 11 Italian population-based screening programs was conducted. Only 25-50-year-old women with a first negative Pap test were included.


RESULTS
Women were classified as ECC+ or ECC- and followed for 4.5 years. The endpoint was the occurrence of a CIN2+ histologic diagnosis. Eligible subjects with negative Pap tests ECC+ and ECC- numbered 469,694 and 20,596, respectively. At least 1 subsequent test was available during follow-up for 335,763 and 11,972 subjects, and 691 and 13 CIN2+ lesions were observed, respectively. The risk of CIN2+ was 2.06 and 1.09 per 1,000 women over 4.5 years, and age-adjusted relative risk associated with ECC--was 0.55 (95% CI 0.28-1.06).


CONCLUSIONS
Women with a negative Pap ECC--have a lower risk of CIN2+ than women with a negative Pap ECC+ and should repeat screening with frequency (3-5 years in Europe), independent of age.
Agency for Public Health, Lazio Region, Rome, Italy. giorgirossi@asplazio.it
Paolo
P
Giorgi Rossi
Diego
D
Baiocchi
Stefano
S
Ciatto
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D065006:Papanicolaou Test; D011364:Professional Practice; D011446:Prospective Studies; D012307:Risk Factors; D013048:Specimen Handling / Q000592:standards*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014626:Vaginal Smears / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology