Abstract
Non-progression and duration of preclinical neoplastic lesions of the cervix uteri were studied using screening data from a previously unscreened population, Maribo County, Denmark (1966-82). To estimate regression rates, the incidence of clinical cancer before the screening programme was related to the prevalence and incidence of preclinical lesions estimated from the detection rates of first smear and third and subsequent smears respectively. Duration was estimated from the time lag between the cumulative incidence of preclinical lesions and the combined cumulative incidence of clinical cancer and the estimated 'incidence of regression'. Of all preclinical lesions in women aged 25-50, 24% progressed, 39% regressed and 38% remained. Even if we assume no onset of preclinical lesions above age 50, we estimated that 48% of the preclinical lesions would not progress to clinical cancer in the women's lifetime. The estimated mean duration of preclinical lesions was 16 years. In Maribo County during the 1970s, the positive rate (1.6%) was low compared with current rates in several countries. We conclude that the detection of non-progressive lesions was outweighed by the prevention of clinical cancer.
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- Boyes D. A., Morrison B., Knox E. G., Draper G. J., Miller A. B. A cohort study of cervical cancer screening in British Columbia. Clin Invest Med. 1982;5(1):1–29. [PubMed] [Google Scholar]
- Gustafsson L., Adami H. O. Natural history of cervical neoplasia: consistent results obtained by an identification technique. Br J Cancer. 1989 Jul;60(1):132–141. doi: 10.1038/bjc.1989.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kurman R. J., Henson D. E., Herbst A. L., Noller K. L., Schiffman M. H. Interim guidelines for management of abnormal cervical cytology. The 1992 National Cancer Institute Workshop. JAMA. 1994 Jun 15;271(23):1866–1869. [PubMed] [Google Scholar]
- Lynge E., Poll P. Incidence of cervical cancer following negative smear. A cohort study from Maribo County, Denmark. Am J Epidemiol. 1986 Sep;124(3):345–352. doi: 10.1093/oxfordjournals.aje.a114404. [DOI] [PubMed] [Google Scholar]
- Magnus K., Langmark F., Andersen A. Mass screening for cervical cancer in Ostfold county of Norway 1959-77. Int J Cancer. 1987 Mar 15;39(3):311–316. doi: 10.1002/ijc.2910390308. [DOI] [PubMed] [Google Scholar]
- Ostör A. G. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993 Apr;12(2):186–192. [PubMed] [Google Scholar]
- Raffle A. E., Alden B., Mackenzie E. F. Detection rates for abnormal cervical smears: what are we screening for? Lancet. 1995 Jun 10;345(8963):1469–1473. doi: 10.1016/s0140-6736(95)91036-0. [DOI] [PubMed] [Google Scholar]
- Singer A. Cervical cancer screening: state of the art. Baillieres Clin Obstet Gynaecol. 1995 Mar;9(1):39–64. doi: 10.1016/s0950-3552(05)80358-x. [DOI] [PubMed] [Google Scholar]
- van Oortmarssen G. J., Habbema J. D. Duration of preclinical cervical cancer and reduction in incidence of invasive cancer following negative pap smears. Int J Epidemiol. 1995 Apr;24(2):300–307. doi: 10.1093/ije/24.2.300. [DOI] [PubMed] [Google Scholar]
- van Oortmarssen G. J., Habbema J. D. Epidemiological evidence for age-dependent regression of pre-invasive cervical cancer. Br J Cancer. 1991 Sep;64(3):559–565. doi: 10.1038/bjc.1991.350. [DOI] [PMC free article] [PubMed] [Google Scholar]