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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2020.826    [Accepted]
Cervical Cancer in Women with Normal Papanicolaou Tests: A Korean Nationwide Cohort Study
Miseon Kim1, Hyeongsu Kim2, Dong Hoon Suh3, Yong Beom Kim3,4
1Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
2Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
3Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
4Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
Correspondence  Yong Beom Kim ,Tel: 82-31-787-7253, Fax: 82-31-787-4054, Email: ybkimlh@snubh.org
Received: August 15, 2020;  Accepted: December 9, 2020.  Published online: December 10, 2020.
ABSTRACT
Purpose
This study aimed to evaluate the risk of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Papanicolau (Pap) tests.
Materials and Methods
The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30-79 between 2007-2012. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1), two (N2), and three consecutive normal Pap tests (N3). Women who did not receive a Pap test during the study period were assigned in the N0 group.
Results
The 1-year cumulative incidence rates of cervical cancer were 58.9, 24.6, 20.3, and 14.2 per 105 in the N0, N1, N2, and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR], 0.825; 95% confidence interval [CI], 0.716 to 0.951) in the N2 group and 42% (RR, 0.578; 95% CI, 0.480 to 0.695) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not higher than that of the N1 group (79.6% vs. 81.3%, p=0.706).
Conclusion
As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests are not associated with improving survival outcomes in women shortly diagnosed with cervical cancer after the last normal Pap test.
Key words: Papanicolaou test, Cervical neoplasms, Survival rate, Incidence, Epidemiologic study
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