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A 3-Year Interval Between Cervical Cancer Screenings Safe if Preceded by 3 or More Consecutive Negative Screening Tests

Data from a large population of racially, ethnically, and geographically diverse women aged 30 to 64 years old indicate that cervical cancer screening can be safely extended to once every 3 years after a series of negative screening tests.

"Our findings provide reassurance to women and their health care providers that extending the intervals between screenings to 3 years after 3 or more consecutive negative Papanicolaou tests is a safe option," writes George F. Sawaya, MD, University of California, San Francisco, United States and colleagues. They analysed the findings of 1,174,727 cervical cytologic tests from 938,576 women included in the National Breast and Cervical Cancer Early Detection Program administered by the Centers for Disease Control and Prevention. The age distribution of the population was 13.6% 30 years and younger, 32.0% 30 to 44 years, 43.8% 45 to 59 years, and 10.6% 60 to 64 years. The population was 52.4% white, 20.5% Hispanic, 14.3% black, 6.5% American Indian/Alaskan Native, 3.6% Asian/Pacific Islander, and 2.7% other or of unknown race or ethnicity.

Among the 32,230 women with 3 or more consecutive negative tests, 9 women (0.028%) had grade 2 and 7 women (0.022%) had grade 3 cervical intraepithelial neoplasia and none had cervical cancer. When the researchers focused the analysis on the 31,728 women aged 30 to 64 years old with 3 or more consecutive negative tests 0.028% had grade 2 and 0.019% had grade 3 cervical intraepithelial neoplasia.

The investigators estimated that with annual Papanicolaou tests for 3 years the risk of cancer was 2 in 100,000 for 30 to 44 years old women, 1 in 100,000 for women in the age groups of 45 to 59 years and 60 to 64 years. The estimated risk of cancer in this population if Papanicolaou tests were conducted every 3 years after 3 or more consecutive negative tests were 5 in 100,000 for 30 to 44 years old women, 2 in 100,000 for 45 to 59 years old women, and 1 in 100,000 for women 60 to 64 years old.

If 100,000 women were screened annually for 3 years rather than once every 3 years after their last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be required in women aged 30 to 44 years to avert 1 additional case of cervical cancer. Among those aged 45 to 59 years old an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations would be needed to avert 1 additional cancer case per 100,000 women.

Continued annual screening in women who have been undergoing cervical cancer screening can reduce the risk of cervical cancer but, the authors conclude "such ongoing screening requires substantial resources and many colposcopic procedures." They add, "the fact that the difference in the risk of cancer is small highlights the importance of attention to the costs and the harms associated with overscreening."

N Engl J Med 2003;349:1501-9.

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