Ebisch Renée M F, Buijssen Celine, Visser Nicole C M, Siebers Albert G, Bekkers Ruud L M
Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands.
Eurofins PAMM, Department of Pathology, Eindhoven, The Netherlands.
J Low Genit Tract Dis. 2025 Jul 1;29(3):229-234. doi: 10.1097/LGT.0000000000000893. Epub 2025 Apr 18.
Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.
People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.
A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.
People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.
荷兰基于人群的宫颈癌筛查在60岁时结束。这项回顾性队列研究旨在确定60岁以上宫颈癌风险增加且可能从延长筛查中获益的人群亚组。
从荷兰全国病理数据库中识别出2000年至2004年作为筛查项目一部分进行宫颈涂片检查异常（索引涂片）的59至61岁有宫颈的人群。与同年龄筛查涂片正常的人群进行1:3匹配。计算后期发生宫颈癌或宫颈上皮内瘤变（CIN）风险的发病率比（IRR）。获得了长达22年的随访数据。
共识别出10368人。索引涂片异常的人群发生CIN和宫颈癌的IRR升高。与正常索引涂片相比，高级别索引涂片人群的这种风险最高；高级别CIN的IRR为104.05（95%CI = 38.18 - 353.18），宫颈癌的IRR为18.58（95%CI = 5.31 - 61.07）。大多数（82%）索引检查异常人群在发生CIN或宫颈癌之前细胞学或组织学检查正常。
59至61岁宫颈涂片检查细胞学异常的有宫颈人群患宫颈癌的终生风险增加19倍，患CIN的风险增加100倍以上。由于这种增加的风险不限于特定时间段，应考虑对该特定群体延长筛查或调整诊断随访。
