title: Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study.
abstract: ObjectiveTo compare the cumulative incidence of cervical cancer diagnosed within 72 months after a normal screening sample between conventional cytology and liquid based cytology tests SurePath and ThinPrep.DesignRetrospective population based cohort study.SettingNationwide network and registry of histo- and cytopathology in the Netherlands (PALGA), January 2000 to March 2013.PopulationWomen with 5 924 474 normal screening samples (23 833 123 person years).ExposureUse of SurePath or ThinPrep versus conventional cytology as screening test.Main outcome measure72 month cumulative incidence of invasive cervical cancer after a normal screening sample for each screening test. Cox regression analyses assessed the hazard ratios, adjusted for calendar time, age, screening history, and socioeconomic status and including laboratories as random effects.ResultsThe 72 month cumulative cancer incidence was 58.5 (95% confidence interval 54.6 to 62.7) per 100 000 normal conventional cytology samples, compared with 66.8 (56.7 to 78.7) for ThinPrep and 44.6 (37.8 to 52.6) for SurePath. Compared with conventional cytology, the hazard of invasive cancer was 19% lower (hazard ratio 0.81, 95% confidence interval 0.66 to 0.99) for SurePath, mainly caused by a 27% lower hazard (0.73, 0.57 to 0.93) of a clinically detected cancer. For ThinPrep, the hazard was on average 15% higher (hazard ratio 1.15, 0.95 to 1.38), mainly caused by a 56% higher hazard of a screen detected cancer (1.56, 1.17 to 2.08).ConclusionsThese findings should provoke reconsideration of the assumed similarity in sensitivity to detect progressive cervical intraepithelial neoplasia between different types of liquid based cytology and conventional cytology.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rozemeijer
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands s.naber@erasmusmc.nl.
authors.forename: Steffie K
authors.initials: SK
authors.lastname: Naber
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: Penning
authors.affiliation: PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, Houten, Netherlands.
authors.forename: Lucy I H
authors.initials: LI
authors.lastname: Overbeek
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Inge M C M
authors.initials: IM
authors.lastname: de Kok
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Suzette M
authors.initials: SM
authors.lastname: Matthijsse
authors.affiliation: Clinical Research Centre and Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
authors.affiliation: Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: van Kemenade
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D003581:Cytodiagnosis / Q000379:methods / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods; D009426:Netherlands / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D014626:Vaginal Smears / Q000379:methods / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology