Cervical cancer risk rises with colposcopy delay after abnormal test results

Key takeaways:

• Cervical cancer risk was higher for women without colposcopy within 12 months of abnormal Pap or HPV test result.
• Cervical cancer risk was not different for women who received colposcopy within 3 to 12 months.

Women with abnormal Pap or HPV test results who did not undergo colposcopy within 12 months had higher risk for subsequent cervical cancer compared with women who received colposcopy within that time frame, researchers reported.

National guideline goals for colposcopy timing vary across organizations, and there is currently no unified consensus based on empirical data, though some guidelines suggest performing colposcopy within 3 months of an abnormal Pap or HPV test, according to Stephanie J. Alimena, MD, gynecologic oncology fellow at Brigham and Women’s Hospital and the Dana Farber Cancer Institute.

“Our data suggest that we should prioritize patients with high-grade abnormal Pap and HPV results while those with low-grade results should have colposcopy within the year after their abnormal result,” Alimena told Healio. “Our results also suggest that clinicians should prioritize women with unknown screening history, either those who had Pap and HPV testing in another health care system and whose records clinicians cannot access to verify any history the patient provides, or those who have never been screened, as these women are at higher risk for cancer.”

Alimena and colleagues conducted a longitudinal analysis of data from 17,541 women aged 21 to 79 years with an abnormal cervical cancer test result from health care systems in Texas, Massachusetts and Washington. Researchers compared colposcopy within 3 months of the abnormal test result with colposcopy at 3 to 12 months and no colposcopy within 12 months in the primary analysis. In the post hoc analyses, researchers compared colposcopy within 12 months with no colposcopy within 12 months.

The primary outcome was a cervical cancer diagnosis 12 months or more after receiving abnormal Pap or HPV test results.

Overall, 53.3% of women underwent colposcopy within 3 months, 22.2% underwent colposcopy within 3 to 12 months and 24.6% did not undergo colposcopy within 12 months. Cervical cancer was diagnosed within 12 months of abnormal test results in 147 women, and they were removed from further analyses.

At more than 1 year after an abnormal Pap or HPV test result, 0.4% of women were diagnosed with cervical cancer. Cervical cancer risk more than 1 year after an abnormal test result was not different for patients who underwent colposcopy within 3 to 12 months (HR = 1.07; 95% CI, 0.54-2.12). However, cervical cancer risk more than 1 year after an abnormal test result was higher for patients who did not undergo colposcopy within 12 months compared with women who had colposcopy within 3 months (HR = 2.34; 95% CI, 1.33-4.14).

In the post hoc analyses, researchers observed a 2.29-fold higher risk for cervical cancer among women without colposcopy within 12 months compared with women who underwent colposcopy within that time frame. Women with high-grade cytology results without colposcopy within 12 months had a 3.12-fold higher risk for cervical cancer compared with women who underwent colposcopy within 12 months.

According to Alimena, future research should explore similar data obtained on patients treated during the COVID-19 pandemic because this study evaluated patients with Pap or HPV test results from only 2010 to 2015.

“Further research should also focus on how to manage abnormal Pap and HPV testing in pregnancy,” Alimena said. “It is unclear if our findings that low-grade results can be safely observed up to 1 year after the result are also applicable to pregnant patients as well. Ideally, if colposcopy can be delayed until postpartum in pregnancy for certain low-risk women, this would be ideal to minimize chances of disrupting the pregnancy, while prioritizing colposcopy during pregnancy only for those with high-risk results. We need further data to explore this topic specifically in pregnant patients.”

For more information:

Stephanie J. Alimena, MD, can be reached at salimena@mgb.org.