title: Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study.
abstract: OBJECTIVE
  To compare the risk of cervical cancer in women with histologically confirmed cervical intraepithelial neoplasia who returned to routine screening after having completed post-treatment follow-up with consecutive normal smear test results with women with a normal primary smear test result.
  
  
  METHODS
  Population based cohort study using data from a nationwide pathology register.
  
  
  METHODS
  The Netherlands, 1994 to 2006.
  
  
  METHODS
  38,956 women with histologically confirmed intraepithelial neoplasia grades 1 to 3 with completed follow-up after treatment.
  
  
  METHODS
  Routine post-treatment follow-up of cervical intraepithelial neoplasia, recommending smear tests at six, 12, and 24 months.
  
  
  METHODS
  Incidence of cervical cancer in the period from completed follow-up with negative test results after cervical intraepithelial neoplasia to the next primary test. 10-year hazard ratios were compared with periods after normal results for the primary smear test, adjusted for year in follow-up.
  
  
  RESULTS
  20 cervical cancers were diagnosed during 56,956 woman years after completed follow-up of cervical intraepithelial neoplasia, whereas 1613 cervical cancers were diagnosed during 25,020,697 woman years after a normal primary smear test result. The incidence of 35.1 (95% confidence interval 21.4 to 54.2) per 100,000 woman years and 6.4 (6.1 to 6.8) per 100,000 woman years, respectively, led to an adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for periods after completed follow-up compared with periods after normal primary smear test results. This hazard ratio was increased for all ages. No significant difference in risk of cervical cancer was observed by grade of cervical intraepithelial neoplasia.
  
  
  CONCLUSIONS
  An excess risk of cervical cancer previously observed for women treated for cervical intraepithelial neoplasia was also observed in the subgroup of women who completed their post-treatment follow-up with three consecutive normal smear test results. The overall corrected risk of cervical cancer in these women was increased fourfold 35 cases per 100,000 woman years) compared with women with normal primary smear test results (6 per 100,000 woman years).
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
authors.forename: Theo
authors.initials: T
authors.lastname: Helmerhorst
authors.forename: Dik
authors.initials: D
authors.lastname: Habbema
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: Rob
authors.initials: R
authors.lastname: Boer
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D060787:Neoplasm Grading; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D014626:Vaginal Smears / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy