Follow-Up of Women with Cervical Cytological Abnormalities: Progression and Regression Events

Aniúsca Vieira Dos Santos,Rosicler Luzia Brackmann,Claudia Giuliano Bica,João Carlos Prolla,Giovana Tavares Dos Santos

doi:10.31557/apjcp.2019.20.4.1019

Abstract

Section TitleAbnormalities in the cervix, when identified early by Pap smear, can be treated in the early stages or in the precursor stages of the neoplasia, which may increase the chances of regression of the lesion. The aim to verify the rate of cervical abnormalities and to evaluate the risk of progression or regression associated with age and cytological diagnosis. Methods:The study was conducted in a referral hospital in Southern Brazil, based on the results of pathology and cytopathology laboratory tests of uterine cervix. The historical cohort included patients with an abnormal cytology diagnosis in the period from January 2010 to December 2014, followed until July 2016. Results:A total of 42,389 cervical smears were analyzed, 4,427 of which were eligible for analysis of the evolution of cervical abnormalities. In progression and regression events analysis, we observed that patients with a cytological diagnosis of atypical glandular cells presented a higher risk of cervical abnormality progression (Hazard Ratio: 2.0 and 95% confidence intervals 1.36–3.48). We also observed that patients younger than 25 years old were more likely to regress the cervical lesions (Hazard Ratio:1.4 and 95% confidence intervals 1.20–1.74). Conclusions:The associations found between the events (progression and regression), age and cytological diagnosis, highlights the importance of cytological screening in populations at risk of precursor of cervical cancer lesions, especially in women older than 25 years.

Highlights

Worldwide, cervical cancer is the most common neoplasm of the female genital tract, accounting for approximately 530,000 new cases and 265,000 deaths per year (Ferlay et al, 2015)
In progression and regression events analysis, we observed that patients with a cytological diagnosis of atypical glandular cells presented a higher risk of cervical abnormality progression (Hazard Ratio: 2.0 and 95% confidence intervals 1.36–3.48)
The mean age of the patients at the beginning of the follow-up was associated with diagnoses of low-grade squamous intra-epithelial lesions (LSIL) and AGC (p

Summary

Introduction

Cervical cancer is the most common neoplasm of the female genital tract, accounting for approximately 530,000 new cases and 265,000 deaths per year (Ferlay et al, 2015). There are other factors that may influence the acquisition and persistence of viral infection as well as regression, stabilization or progression of cervical lesions and atypia, causing different rates of disease around the world (zur Hausen, 2002; Castellsagué and Muñoz, 2003; de Freitas et al, 2012; WHO, 2014; CDC, 2018). In this regard, screening programs based on cytology examinations continue to be the mainstay of cervical cancer prevention, especially in underdeveloped or developing countries. Abnormalities in the uterine cervix may be treated in the early stages or in the precursor phases of the neoplasm, increasing the lesion regression chances (WHO, 2014; INCA, 2015)

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