Objective: To evaluate the impact of consecutive normal results in cytology on cervical cancer incidence and mortality.
Methods: The database of the National Health Insurance Service (NHIS) was used. We obtained all cytology results of women aged 30-79 in National Cancer Screening Program (NCSP) in 2011 and 2012, and analyzed 7-year cumulative incidences and 5-year survival rates of cervical cancer by consecutive normal results in cytology before.
Results: In 2,740,063 women, a total of 2,577,070 (94.0.51%) women had a normal cytology result in 2011 or 2012. The 7-year cumulative case of cervical cancer was 2,779 in these women. It was significantly lower than those of 6,160,664 women who never undergo cytology for 5 years (0.108% vs. 0.211%, HR=0.512, 95% CI=0.491-0.533; p<0.001). Compared to women with a normal cytology result only once, the 7-year cumulative incidences gradually decreased in women with two (1,168/1,352,226 [0.086%], HR=0.801, 95% CI=0.748-0.858; p<0.001) and three (675/962,156 [0.070%], HR=0.651, 95%=0.604-0.715; p<0.001) consecutive normal cytology results. However, the 5-year survival rates in women with two (80.0%, HR=1.016, 95% CI=0.822-1.256, p=0.885) and three (79.6%, HR=1.021, 95% CI=0.774-1.347, p=0.881) consecutive normal cytology results were not different compared to those of only a normal cytology result (81.3%).
Conclusion: As normal cytology results are consecutively repeated, the incidences of cervical cancer significantly decrease. However, consecutive normal cytology results before cancer diagnosis are not associated with improved survival outcomes in women with cervical cancer.