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186 Compliance with follow-up after low-grade cervical smear results and the long term risk of developing cervical cancer
  1. Ruud LM Bekkers1,
  2. Renee FM Ebisch1,
  3. Bert Siebers2,
  4. Johan Bulten1 and
  5. Karlijne AMT Houkes1
  1. 1RadboudUMC, Nijmegen, The Netherlands
  2. 2Palga, Houten, The Netherlands


Introduction/Background ASC-US and LSIL smears are diagnosed frequently in cervical screening programs. Only 5–15% of the low-grade cervical abnormalities may develop into high grade lesions, and about 1% in cervical cancer. Compliance to recommended follow-up after ASC-US/LSIL is known to variate.

Objective To examine the risk of developing CIN3 or cervical cancer after ASC-US/LSIL cytology, in relation to compliance with recommended follow-up.

Methodology Retrospective population-based 1:3 frequency matched cohort study comparing women with ASC-US/LSIL non-compliant (cases) to women compliant (controls) to the recommended follow-up. Women, diagnosed with ASC-US/LSIL between 1 January 2000 and 31 December 2005, were selected from and matched by the Dutch Nationwide Pathology Databank (Palga). Women with a prior history of CIN3 or cervical cancer were excluded from the study. Cases of CIN1–3 and cervical cancer were identified until 31 May 2020.

Results Mean follow up after ASCUS/LSIL was 12 years (2–20 years). Of 9,616 women not compliant to follow-up, 481 women (5.0%) developed CIN3 and 3 women (0.03%) cervical cancer. Of 28,829 women compliant to follow-up, 1192 women (4.13%) developed CIN3 and 11 women (0.04%) developed cervical cancer. Women compliant to follow up were significantly more often (>15 times more) treated for CIN1/2 (14.8% against 0.8%), had significantly less often CIN 3, and had a significant shorter time to their CIN 3 diagnosis.

Conclusion Cervical cancer incidence for women with an ASC-US/LSIL cervical smear result was not affected by compliance to follow-up. However, women who were non-compliant to follow-up had a higher incidence of detected CIN3, while excisional rates in women compliant to follow-up were significantly higher, indicating overtreatment of CIN1 and CIN2. Further research is warranted to optimize follow-up strategies for women with anASC-US/LSIL in a both primary cytological and HPV screening settings.

Disclosures None.

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