Women with lesion history need smear tests after 60

Women should be offered annual smear tests for at least 25 years after treatment for precancerous lesions, say Swedish researchers.

Recent findings indicate that women are still at risk of developing invasive cancer of the cervix even after treatment for grade-three cervical intraepithelial neoplasmia. This emphasises the need for regular screening even beyond the age of 60, say the researchers.

Data from the National Swedish Cancer Register on 132,493 women, recorded between 1958 and 2002, who had a diagnosis of severe dysplasia, was examined.

Using patient registration numbers, it was noted that 881 women had a diagnosis of invasive cervical cancer and 111 women had a diagnosis of vaginal cancer more than one year after undergoing treatment for severe dysplasia. Increased risk of cervical cancer in women who were aged 35 plus when treated for severe dysplasia was also found.

Women were two fold more likely to develop invasive cervical cancer after a diagnosis of severe dysplasia if the diagnosis was made between 1991 and 2000 than between 1958 and 1970.

Lead researcher Dr Bjorn Strander, senior consultant at the department of obstetrics and gynaecology at the University of Gothenburg, said: 'It must be considered a failure of the medical service when women participate in screening, their precancerous lesions are found, they subject themselves to treatment of those lesions, presumably participate in follow-up programmes and still develop invasive cancer.'

Follow-up care has been insufficient and women should be offered annual smear tests for at least 25 years after treatment, said Dr Strander.

Long-term follow-up should not stop for women when they reach the age of 60 if they were older than 35 at the time of treatment, he added.

sanjay.tanday@haymarket.com

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