Incidence of cervical cancer after several negative smear results by age 50: Prospective observational study

Objective: To determine the incidence of cervical cancer after several negative cervical smear tests at different ages. Design: Prospective observational study of incidence of cervical cancer after the third consecutive negative result based on individual level data in a national registry of histopathology and cytopathology (PALGA). Setting: Netherlands, national data. Population: 218 847 women aged 45-54 and 445 382 aged 30-44 at the time of the third negative smear test. Main outcome measures 10 year cumulative incidence of interval cervical cancer. Results: 105 women developed cervical cancer within 2 595 964 woman years at risk after the third negative result at age 30-44 and 42 within 1 278 532 woman years at risk after age 45-54. During follow-up, both age groups had similar levels of screening. After 10 years of follow-up, the cumulative incidence rate of cervical cancer was similar: 41/100 000 (95% confidence interval 33 to 51) in the younger group and 36/100 000 (24 to 52) in the older group (P=0.48). The cumulative incidence rate of cervical intraepithelial neoplasia grade I+ was twice as high in the younger than in the older group (P<0.001). Conclusions: The risk for cervical cancer after several negative smear results by age 50 is similar to the risk at younger ages. Even after several negative smear results, age is not a good discriminative factor for early cessation of cervical cancer screening.