title: Are Women Who Exit Colposcopy Without Treatment at Elevated Risk for Cervical Cancer?
abstract: OBJECTIVE
  This study aims to estimate the risk of cervical cancer and impact of treatment and other factors in women referred for high-grade (HG) and low-grade (LG) cytologic changes and discharged from colposcopy.
  
  
  METHODS
  A retrospective cohort study identified 14,787 and 41,916 women with a first-time HG and LG cytologic abnormality between 2007 and 2010 and underwent colposcopy within 1 year. Treatment status was determined within the episode of care. Incidence of cervical cancer postcolposcopy was determined up to March 2015. Logistic regression assessed impact of colposcopic care and patient factors on cancer risk.
  
  
  RESULTS
  A total of 62% HG and 28.5% LG had treatment. A total of 28% and 37% with HG and LG abnormalities had only 1 colposcopic evaluation. Subsequent cancer incidence in the untreated HG group was 1.1% versus 0.3% in the treated group. For the LG group, cancer rates were 0.08% in both treatment groups. In the HG group, those with initial colposcopy only and no treatment had an elevated risk [adjusted odds ratio = 6.6 (95% CI = 3.9-11)] compared with treatment with multiple follow-ups. Other significant factors were advancing age and no screening postcolposcopy. For the LG group, those with initial colposcopy only were more at risk regardless of treatment [adjusted odds ratio = 3.8 (95% CI = 1.8-8.1)] compared with multiple colposcopies.
  
  
  CONCLUSIONS
  Women who are untreated, with index HG cytology, remain at elevated risk for cervical cancer when the colposcopic episode is limited to 1 examination. Centralized programs are required to ensure that such women are not discharged prematurely or lost to follow up from colposcopy and subsequent screening.
authors.affiliation: 1Cancer Screening, Cancer Care Ontario, Dalla Lana School of Public Health/Health System Performance Research Network, University of Toronto, Toronto, Ontario, Canada; 2Cancer Screening, Cancer Care Ontario, Toronto, Ontario, Canada; and 3Cancer Screening, Cancer Care Ontario. University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Koné Péfoyo
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Julia
authors.initials: J
authors.lastname: Gao
authors.forename: Rachel
authors.initials: R
authors.lastname: Kupets
mesh_terms: D000328:Adult; D000368:Aged; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult