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Cervical Cancer in Women with Normal Pap Tests: A Korean Nationwide Cohort Study
17 Pages Posted: 20 Jul 2020
More...Abstract
Background: The Papanicolaou (Pap) test has a considerable false-negative rate in cervical cancer screening. However, no nationwide study has demonstrated the cumulative effect of consecutive normal Pap tests on cervical cancer risk. We evaluated cumulative incidence and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Pap test.
Methods: The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30‒79 in the National Cancer Screening Program between 2007‒2012 and cervical cancer incidence data from insurance benefit claims until 2013. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1 group, n=2,577,070), two (N2 group, n=1,352,226), and three consecutive normal Pap tests (N3 group, n=962,156) consecutively. Women who did not receive a Pap test during the study period were assigned in the N0 group (n=6,160,664).
Findings: The 1-year cumulative incidence rates of cervical cancer were 58∙9 per 105, 24∙6 per 105, 20∙3 per 105, and 14∙2 per 105 in the N0, N1, N2 and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR]=0∙8253, 95% confidence interval [CI]=0∙7164‒0∙9508, p=0∙0078) in the N2 group and 42% (RR=0∙5779, 95% CI=0∙4804‒0∙6951, p<0∙0001) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not significantly higher than that of the N1 group (79∙6% vs. 81∙3%, RR=1∙0906, 95% CI=0∙6946‒1∙7124, p=0∙7064).
Interpretation: As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests before cancer diagnosis are not associated with improving survival outcomes in women diagnosed with cervical cancer within the year after the last normal Pap test.
Funding Statement: This study was supported by a grant from the Seoul National University Bundang Hospital Research Fund (no. 02-2017-023)
Declaration of Interests: The authors have no disclosures to report.
Ethics Approval Statement: This study was reviewed and approved by the Institutional Review Boards (approval no. X-1906-549-901) of Seoul National University Bundang Hospital, and the National Health Insurance Service (NHIS) database was used (approval no. NHIS-2020-1-059).
Keywords: Papanicolaou test; cervical cancer; survival rate; incidence; epidemiologic study
Suggested Citation: Suggested Citation