Risk of invasive cervical cancer in relation to management of abnormal Pap smear results

Research output: Contribution to journalArticle


OBJECTIVE: We sought to evaluate the management of women with abnormal cytology in terms of subsequent risk of invasive cervical cancer. STUDY DESIGN: The screening histories of all invasive cervical cancer cases diagnosed in Sweden 1999-2001 and of 5 population-based controls per case were reviewed. In all, 159 patients and 258 control subjects aged < 67 years had an abnormal smear result 0.5-6.5 years prior to cancer diagnosis. The cervical cancer risk was estimated in relation to management by calculating odds ratios. RESULTS: Histologic assessment of low-grade squamous abnormalities strongly reduced the risk compared to repeated cytology (odds ratio, 0.46; 95% confidence interval, 0.24-0.89). Delaying histologic assessment was also associated with a higher risk ( odds ratio, 5.65; 95% confidence interval, 1.39-23.05). After high-grade squamous atypia, absence of any cytologic or histologic specimen was a major determinant of cancer risk (odds ratio, 12.52; 95% confidence interval, 1.42-infinitive). CONCLUSION: For adequate protection against invasive cervical cancer, further assessment with histology must be recommended also for women with low-grade squamous abnormalities.


  • Lena Silfverdal
  • Levent Kemetli
  • Bengt Andrae
  • Par Sparen
  • Walter Ryd
  • Joakim Dillner
  • Bjorn Strander
  • Sven Tornberg
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine


  • population-based case control study, smear results, repeated cytology, management of abnormal Pap, cervical cancer risk, histologic assessment
Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Issue number2
Publication statusPublished - 2009
Publication categoryResearch