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.
Reference:
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.
Contacts:
Jiangrong
Wang Pär
Sparén
Phone: +46-8-524 822 34 +46-70-794
46 74
E-mail: jiangrong.wang@ki.se par.sparen@ki.se