Substantial cancer risk in women with abnormal glandular cells in their cervical smear
National long-term follow-up of all women in Sweden who have had atypical glandular cells in their cervical smears , using the Swedish cervical screening registry (NKCx), provides unambiguous data on cancer risk that are now published in the prestigious journal BMJ.
Women with abnormal glandular cells of the cervix have a substantial and long-term increased risk of cervical cancer, even when followed-up by a specialist. Better follow-up strategies will be needed.
"Is it dangerous? Do I need to be worried?" are common questions when women are told that their cervical screening result is abnormal. The cancer risk after most types of abnormalities is well known and are drastically reduced after treatment. But, when the atypical result is glandular cell atypia, it has not been possible to provide an unambiguous answer. Sufficiently large long-term follow-up studies have been lacking.
All cases of cervical cancer that occurred among more than 3 million Swedish women who participated in cervical screening were studied. Nearly three percent of women with atypical glandular cells developed invasive cervical cancer after fifteen years of follow up, which is a high proportion. The cancer risk was particularly high for women who had atypical glandular cells in their smears when they were 30-39 years old.
Only slightly more than half of the women with atypical glandular cells were followed up with histology, compared with almost ninety percent of women with other severe abnormalities, which might explain why the cancer risk remained high in spite of referral for clinical management. The study suggests that follow-up could be improved by addition of least one additional histology within a year and a more active long-term follow-up. Regionally centralized specialist care for these women is another possibility.
Wang J, Andrae B, Sundström K, Ström P, Ploner A, Elfström KM, Arnheim-Dahlström L, Dillner J, Sparén P. Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study. BMJ. 2016 Feb 11;352:i276. doi: 10.1136/bmj.i276.
Jiangrong Wang Pär Sparén
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