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Are Women Who Exit Colposcopy Without Treatment at Elevated Risk for Cervical Cancer?

Koné Péfoyo, Anna J. BEng, MSc, PhD; Wang, Li MD, MSc; Gao, Julia MSc; Kupets, Rachel MD, MSc

Journal of Lower Genital Tract Disease: January 2017 - Volume 21 - Issue 1 - p 47–54
doi: 10.1097/LGT.0000000000000265
Original Research Articles: Cervix and HPV

Objective This study aims to estimate the risk of cervical cancer and impact of treatment and other factors in women referred for high-grade (HG) and low-grade (LG) cytologic changes and discharged from colposcopy.

Materials and Methods A retrospective cohort study identified 14,787 and 41,916 women with a first-time HG and LG cytologic abnormality between 2007 and 2010 and underwent colposcopy within 1 year. Treatment status was determined within the episode of care. Incidence of cervical cancer postcolposcopy was determined up to March 2015. Logistic regression assessed impact of colposcopic care and patient factors on cancer risk.

Results A total of 62% HG and 28.5% LG had treatment. A total of 28% and 37% with HG and LG abnormalities had only 1 colposcopic evaluation. Subsequent cancer incidence in the untreated HG group was 1.1% versus 0.3% in the treated group. For the LG group, cancer rates were 0.08% in both treatment groups. In the HG group, those with initial colposcopy only and no treatment had an elevated risk [adjusted odds ratio = 6.6 (95% CI = 3.9–11)] compared with treatment with multiple follow-ups. Other significant factors were advancing age and no screening postcolposcopy. For the LG group, those with initial colposcopy only were more at risk regardless of treatment [adjusted odds ratio = 3.8 (95% CI = 1.8–8.1)] compared with multiple colposcopies.

Conclusions Women who are untreated, with index HG cytology, remain at elevated risk for cervical cancer when the colposcopic episode is limited to 1 examination. Centralized programs are required to ensure that such women are not discharged prematurely or lost to follow up from colposcopy and subsequent screening.

Women untreated, with index high-grade cytology, remain at elevated cervical cancer risk and should not be lost from colposcopy and subsequent screening or discharged prematurely. Supplemental digital content is available in the text.

1Cancer Screening, Cancer Care Ontario, Dalla Lana School of Public Health/Health System Performance Research Network, University of Toronto, Toronto, Ontario, Canada; 2Cancer Screening, Cancer Care Ontario, Toronto, Ontario, Canada; and 3Cancer Screening, Cancer Care Ontario. University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada

Reprint requests to: Rachel Kupets, MD, MSc, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. E-mail:

The authors have declared they have no conflicts of interest.

The study was approved by the REB of Sunnybrook Health Sciences Center in Toronto.

This research did not receive any financial support. It was an internal “Cancer Care Ontario” evaluation project, undertaken for the needs of the Ontario Cervical Screening Program.

Ministry of Health and Long-Term Care (MOHLTC) data was used in the analysis. The views expressed in the report are those of the authors and do not reflect those of the MOHLTC or the Government of Ontario.

Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements herein are those of the authors and not necessarily those of CIHI.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2017 by the American Society for Colposcopy and Cervical Pathology