HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yasmeen, S. Articles by Hendrix, S. L. Search for Related Content PubMed PubMed Citation Articles by Yasmeen, S. Articles by Hendrix, S. L. Related Collections General gynecology Cytology/colposcopy Epidemiology/public health

Incidence of Cervical Cytological Abnormalities With Aging in the Women’s Health Initiative

A Randomized Controlled Trial

From the ¹University of California, Davis, Davis, California; ²Women’s Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, Washington; ³University of Iowa, Iowa City, Iowa; ⁴University of California Irvine, California; ⁵State University of New York, Stony Brook, New York; ⁶Wayne State University School of Medicine, Detroit, Michigan.

OBJECTIVE: To estimate the incidence of cytological abnormalities and cervical cancer and to determine the effect of oral estrogen and progestin on cervical cytology among postmenopausal women participating in a multi-institution clinical trial.

METHODS: The study was a longitudinal analysis of a prospective cohort of 16,608 postmenopausal women (aged 50–79 years) participating in the Women’s Health Initiative (WHI) clinical trial of estrogen plus progestin. Eligible participants had a cervical smear within 1 year before randomization and at 3- and 6-year follow-ups. Outcomes measured were low-grade and high-grade squamous intraepithelial lesions (LSIL, HSIL) and cervical cancer at follow-up years 3 and 6.

RESULTS: Of 15,733 eligible participants with a uterus, 7,663 were assigned to placebo and 8,070 to estrogen plus progestin. At baseline, 318 women (2%) had low-grade abnormalities on cervical cytology. The annual incidence rate of any new cytological abnormality in the estrogen plus progestin group was significantly higher than that in the placebo group (hazard ratio 1.4, 95% confidence interval [CI] 1.2–1.6). Independent risk factors for HSIL and cervical cancer over a 6-year follow-up (after stratifying for baseline cytologic abnormalities) included sexual activity in the past year while not being married or living as married (hazard ratio 3.5, 95% CI 1.5–8.3). Risk factors did not include age or use of estrogen plus progestin.

CONCLUSION: Use of estrogen plus progestin was associated with increased incidence of any cytologic abnormality, although it had no impact on the incidence of HSIL or cervical cancer. Sexually active older women who are not married or living as married may benefit from continued cervical cancer screening.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00000611

LEVEL OF EVIDENCE: I

This article has been cited by other articles:

				Should Women Continue to Have Pap Smears Past 65? Journal Watch (General), September 7, 2006; 2006(907): 5 - 5. [Full Text]