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Protection Against Squamous Cell Carcinoma and Cervical Adenocarcinoma Afforded by Cervical Cytology Screening: A Cross-Sectional Study

Vale, Diama Bhadra MD, PhD*; Braganca, Joana Froes MD, PhD*†; Morais, Sirlei Siani PhD†‡; Zeferino, Luiz Carlos MD, PhD*†

International Journal of Gynecological Cancer: February 2014 - Volume 24 - Issue 2 - p 321–328
doi: 10.1097/IGC.0000000000000057
Cervical Cancer

Objective: The objective of this study was to evaluate the impact of cervical cytology screening on the prevalence of cervical cytological results in women, as a function of age and test interval.

Methods: This is a cross-sectional study of cytology screening data of 2,002,472 tests obtained from previously screened women and 217,826 tests from unscreened women. The central cytopathology laboratory database was analyzed. The tests were collected for screening purposes from Campinas metropolitan region, Brazil. A prevalence ratio (PR) with a 95% confidence interval was calculated for the screened women, in relation to the unscreened women, and for different tests intervals. Protection afforded by screening (1-PR) was calculated.

Results: For high-grade squamous intraepithelial lesion, the PR was 0.97 (0.83–1.13) for women aged 20 years or younger and 0.99 (0.86–1.14) for women aged 20 to 24 years, decreasing significantly in women aged 25 to 29 years (PR, 0.63 [0.52–0.76]). The PR for squamous cell carcinoma, adenocarcinoma in situ (AIS), and invasive adenocarcinoma showed a significant reduction in all age groups older than 30 years. For the age group ranging from 30 to 59 years, protection for squamous cell carcinoma, AIS, and invasive adenocarcinoma was 83% or higher for screening intervals from 1 to 5 years. Protective effect was not demonstrated for screening intervals longer than 5 years for AIS and invasive adenocarcinoma.

Conclusions: Cytology screening is effective at preventing cytological high-grade squamous intraepithelial lesion, squamous cell carcinoma, AIS, and invasive adenocarcinoma. On the basis of cytological results, protection against AIS and invasive adenocarcinoma was observed with screening intervals shorter than 5 years. Cytological screening in women 25 years or younger should be critically evaluated.

*School of Medical Sciences, State University of Campinas; †Center for Comprehensive Assistance to Women’s Health (CAISM) - Dr José Aristodemo Pinotti Women’s Hospital, State University of Campinas, Campinas; and ‡Jundiaí Medical School, Jundiaí, Brazil.

Address correspondence and reprint requests to Luiz Carlos Zeferino, MD, PhD, Department of Obstetrics and Gynecology, Oncology Division, Universidade Estadual de Campinas, Rua Alexander Fleming 101, CEP 13083-881, Campinas, Sao Paulo, Brazil. E-mail: zeferino@fcm.unicamp.br.

The authors declare no conflicts of interest.

Received September 3, 2013

Received in revised form November 3, 2013

Accepted November 4, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.