• Matejka Rebolj, Theo Helmerhorst, Dik Habbema, Caspar Looman, Rob Boer, Joost van Rosmalen, and Marjolein van Ballegooijen.
• Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
• BMJ. 2012 Jan 1;345:e6855.

ObjectiveTo compare the risk of cervical cancer in women with histologically confirmed cervical intraepithelial neoplasia who returned to routine screening after having completed post-treatment follow-up with consecutive normal smear test results with women with a normal primary smear test result.DesignPopulation based cohort study using data from a nationwide pathology register.SettingThe Netherlands, 1994 to 2006.Population38,956 women with histologically confirmed intraepithelial neoplasia grades 1 to 3 with completed follow-up after treatment.InterventionRoutine post-treatment follow-up of cervical intraepithelial neoplasia, recommending smear tests at six, 12, and 24 months.Main Outcome MeasureIncidence of cervical cancer in the period from completed follow-up with negative test results after cervical intraepithelial neoplasia to the next primary test. 10-year hazard ratios were compared with periods after normal results for the primary smear test, adjusted for year in follow-up.Results20 cervical cancers were diagnosed during 56,956 woman years after completed follow-up of cervical intraepithelial neoplasia, whereas 1613 cervical cancers were diagnosed during 25,020,697 woman years after a normal primary smear test result. The incidence of 35.1 (95% confidence interval 21.4 to 54.2) per 100,000 woman years and 6.4 (6.1 to 6.8) per 100,000 woman years, respectively, led to an adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for periods after completed follow-up compared with periods after normal primary smear test results. This hazard ratio was increased for all ages. No significant difference in risk of cervical cancer was observed by grade of cervical intraepithelial neoplasia.ConclusionsAn excess risk of cervical cancer previously observed for women treated for cervical intraepithelial neoplasia was also observed in the subgroup of women who completed their post-treatment follow-up with three consecutive normal smear test results. The overall corrected risk of cervical cancer in these women was increased fourfold 35 cases per 100,000 woman years) compared with women with normal primary smear test results (6 per 100,000 woman years).

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