Risk of Invasive Cervical Cancer After Glandular Atypia on PAP Smear

MedicalResearch.com Interview with:

Jiangrong Wang PhD Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm, Sweden

Dr. Jianrong Wang

Jiangrong Wang PhD
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
Stockholm, Sweden

Medical Research: What is the background for this study? What are the main findings?

Dr. Wang: Cervical screening has been proved to effectively suppress the occurrence of cervical cancer, since it detects not only cervical cancer at early stages, but also precursor lesions that can be treated before progressing to invasive cancers. However, cervical screening has mainly reduced the occurrence of squamous cell cervical cancer, the most common type of invasive cervical cancer, but not adenocarcinoma of the cervix which originates from glandular cells. Although there is a well-known connection between adenocarcinoma in situ and invasive adenocarcinoma, questions remain on the magnitude of the cancer risk after detection of the glandular intraepithelial lesion-atypical glandular cells (AGC). We also wanted to study whether the current clinical management after detection of glandular abnormalities reduced the cancer risk as much as the standard management for squamous intraepithelial lesions does.

Our findings show that 2.6% of women with  intraepithelial lesion-atypical glandular cells as the first abnormality developed invasive cervical cancer after 15 years of follow up and 74% of the cancers were adenocarcinoma. A moderately high proportion of women with AGC had prevalent cancer (diagnosed within 6 months from AGC), while there was considerably high incidence of cervical cancer within 0.5-6.5 years after a detection of AGC. The incidence of cervical cancer following AGC was significantly higher than for high-grade squamous intraepithelial lesions, and this increased risk remained even after having histology assessment in the initial half year.

The high risk of cervical cancer associated with AGC implies that the current clinical management following AGC does not prevent cervical cancer as sufficiently as the management for squamous intraepithelial lesions does.


Medical Research: What should clinicians and patients take away from your report?

Dr. Wang: Clinicians should be aware of the increased risk of cervical cancer following intraepithelial lesion-atypical glandular cells, and pay more attention on assessing and following women with AGC in order to find and treat precursor lesions or early staged cervical cancer. However, patients with AGC in screening do not need to be over-worried, as the great majority will not develop cancers.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Wang: The stage of cervical cancer found following  intraepithelial lesion-atypical glandular cells could be assessed to evaluate the effect of the clinical management. The optimal clinical management for AGC to suppress the cancer risk should be further investigated.

Medical Research: Is there anything else you would like to add?

Dr. Wang: According to previous publications, testing for Human Papillomavirus (HPV) infection in cervical screening can help stratify women with high and low risk of cervical cancer following AGC1. It can confine the number of women being intensely assessed or followed up after the detection of  intraepithelial lesion-atypical glandular cells, without losing the real high risk group.


Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPV-negative high-grade Pap results. J Low Genit Tract Dis 2013;17
(Suppl 1):S50-5.

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Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i276 (Published 11 February 2016) Cite this as: BMJ 2016;352:i276

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Jiangrong Wang PhD (2016). Risk of Invasive Cervical Cancer After Glandular Atypia on PAP Smear