Cervical Cancer Rates Higher in Women With Abnormal Cervical Cells Who Don’t Get Treated

A new study published in the Journal of Lower Genital Tract Disease has found that women with moderate to severe changes in their cervical cells are nearly 4 times more likely to develop cervical cancer when they don’t get treatment or follow-up testing, compared women who are treated.

The study, co-authored by Dr. Rachel Kupets, Scientific Lead for the Ontario Cervical Screening Program (OCSP) with Cancer Care Ontario, included women ages 21 to 69 in Ontario who had an abnormal Pap test for the first time between 2007 and 2010.

The Pap test checks for abnormal cervical cells that could turn into cervical cancer and is done by a physician or nurse. Cancer Care Ontario’s clinical guidelines recommend that women ages 21 to 69 who are or ever have been sexually active get screened every 3 years with a Pap test.

Women with abnormal Pap test results may need a follow-up procedure, called a colposcopy. During a colposcopy, the part of the cervix where abnormal cells are most likely to form is lit up and magnified so it can be seen more clearly. The doctor doing the colposcopy may also remove or take a biopsy of abnormal-looking tissues, called lesions. In some cases, women will need more than one colposcopy to remove their lesions.

“While some lesions detected during colposcopy do not require immediate treatment, these findings demonstrate the importance of ensuring that women are receiving appropriate and timely follow-up care,” says Dr. Kupets.

Key study findings:

• Women with moderate to severe abnormal cervical cells (known as high-grade dysplasia) who did not get treated with colposcopy had a cervical cancer rate of 1.1%, compared with 0.3% for women who were treated.
• The risk of cervical cancer increased with age in women with moderate to severe abnormal cervical cells (high-grade dysplasia) who did not get follow-up treatment or testing. The highest risk was in women ages 60 to 69.

The study also showed that treatment patterns varied based on the type of cell changes or what the healthcare provider observed when they examined the cervix. “Developing a clear set of guidelines for colposcopists, physicians and nurses would help ensure that all women are being properly monitored and no lesions are missed,” says Dr. Kupets.

The OCSP is a province-wide organized cancer screening program that aims to reduce cervical cancer incidence (new cases) and mortality (deaths) by finding and treating pre-cancerous or cancerous lesions at an early stage.

OCSP guidelines recommend that women with abnormal Pap test results who did not need treatment get a Pap test every year to make sure their cervical cells go back to normal.

Cervical cancer is almost entirely preventable with regular screening, appropriate and timely follow-up of abnormal results and human papillomavirus (HPV) immunization. However, participation in the OCSP decreased from 68% in 2009–2011 to 63% in 2012–2014.

Visit Screening for Cervical Cancer for more information on cervical cancer screening in Ontario.

Learn more about recommended best practices for the delivery of colposcopy services in Ontario here.

About the study

The study, published in the January issue of the Journal of Lower Genital Tract Disease, looks at the impact of treatment and other factors on cervical cancer risk in women with moderate to severe abnormal cervical cells (high-grade dysplasia) who have completed their colposcopy treatment.

This study included 14,787 and 41,916 women who had moderate to severe abnormal cervical cells for the first time between 2007 and 2010 and colposcopy within one year.

The factors associated with the risk of developing cervical cancer were determined by looking at women who had colposcopy as a result of an abnormal Pap test.

The study was co-authored by the following people:

• Anna J. Koné Pefoyo (Department of Prevention and Cancer Control, Cancer Care Ontario and Dalla Lana School of Public Health, University of Toronto)
• Li Wang (Department of Prevention and Cancer Control, Cancer Care Ontario)
• Julia Gao (Department of Prevention and Cancer Control, Cancer Care Ontario)
• Dr. Rachel Kupets (Scientific Lead, Ontario Cervical Screening Program and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology University of Toronto, Sunnybrook Health Sciences Centre)

View a copy of the study abstract.