Study reveals low but rising cervical cancer risk after screening exit
A new study found that while cervical cancer risks remain low for women who meet screening exit criteria, they increase with age and time since last screening.
Study reveals low but rising cervical cancer risk after screening exit | Image Credit: © Queenmoonlite Studio - © Queenmoonlite Studio - stock.adobe.com.
Cervical cancer risks after screening exit
While risks of cervical cancer and cervical cancer mortality are low among US women fulfilling the criteria to exit screening with contesting, these risks increase with age and the time since exiting, according to a recent study published in JAMA Network Open.1
According to 2012 guidelines developed by multiple national health organizations, female patients can exit screening when aged 65 years if they have undergone adequate screening.2 This is defined as 3 consecutive negative Papanicolaou test results or 2 consecutive negative concurrent human papillomavirus (HPV) and Papanicolaou test results when aged at least 55 years.1
“While modeling has been used to estimate the risk of cancer in females who have been screened with cytology or HPV-based tests, to our knowledge, the risk in the subgroup of females who have met the cotesting criteria to exit screening in the US has not been estimated,” wrote investigators.
Study design and methods
The comparative modeling study was conducted to validate model-estimated 3- and 5-year cervical intraepithelial neoplasia grade 3 (CIN3) risks. There were 4 Cancer Intervention and Surveillance Modeling Network-Cervical Cancer models included in the analysis.
Alongside CIN3, these models estimated cervical cancer and cervical cancer mortality risks. Survival was reported through age-, stage-, and time-dependent estimates, with age-specific estimates used to account for non-cervical cancer-related deaths.
Transition probabilities between health states were considered key differences among models. Additional differences across models included the estimated time between HPV infection and incident cancer and assumptions about progression risk between stages of cancer.
The models were compared by assuming tests with perfect sensitivity were performed at 3- and 5-years following screening exit because the necessary criteria were met. Cumulative and age-conditional risks of cervical cancer incidence and death were reported as the primary outcomes.
Comparisons were performed across 4 scenarios. The first scenario was no screening prior to exit cotests, the second a single cotest prior to exit cotests, the third adhering to US screening guidelines, and the fourth adhering to Kaiser Permanente Northern California screening guidelines.
Key findings
Similar 3-year risks were reported across the 4 models in scenario 1, ranging from 0.035% to 0.038%. While this exceeded the upper bound of the 95% confidence interval (CI) from Landy et al, the 5-year risks were within the 95% CI ranging from 0.075% to 0.083%.
In scenario 3, the 3-year risks also exceeded the 95% CI while 5-year risks fell within the 95% CI. Ranges were 0.032% to 0.048% and 0.076% to 0.092%, respectively. No link was reported between adhering to US screening guidelines and reduced CIN3 risks vs scenario 1. However, higher CIN3 risks were reported in scenario 3.
Similar results as models 1 and 3 were reported for models 2 and 4. When evaluating mortality, reduced risks of cervical cancer and cervical cancer mortality were reported in patients with a history of guideline-based screening vs those with only 2 consecutive negative cotests before the scenario.
Overall, the risks of cervical cancer were from 0.001% to 0.003% by the age of 70 years vs 0.026% to 0.081% by the age of 5 years in scenario 1. For cervical cancer mortality, these ranges were 0% to 0.001% and 0.005% to 0.038%, respectively.
In scenario 3, cervical cancer and cervical cancer mortality risks by the age of 85 years ranged from 0.023% to 0.077% and from 0.004% to 0.032%, respectively. Scenario 2 had similar results to scenario 1, while scenario 4 had similar results to scenario 3.
Conclusion
These results indicated low cervical cancer and cervical cancer mortality risks as measured by 4 models. However, these results were sensitive to assumptions about HPV incidence, which may increase as the cohorts age.
“Evaluation of alternative strategies should consider not only the associated cancer and cancer mortality risks but also screening-related harms, taking into account the increasing burden of comorbidities and the competing risk of death in older women,” concluded investigators.
References
- Kulasingam SL, de Kok IMCM, Mehta A, et al. Estimated cancer risk in females who meet the criteria to exit cervical cancer screening. JAMA Netw Open. 2025;8(3):e250479. doi:10.1001/jamanetworkopen.2025.0479
- Moyer VA; US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156(12):880-891. doi:10.7326/0003-4819-156-12-201206190-00424
