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The positive predictive value of cervical smears in previously screened postmenopausal women: the Heart and Estrogen/progestin Replacement Study (HERS) Journal Article


Authors: Sawaya, G F; Grady, D; Kerlikowske, K; Valleur, J L; Barnabei, V M; Bass, K; Snyder, T. E.; Pickar, J H; Agarwal, S K; Mandelblatt, J
Article Title: The positive predictive value of cervical smears in previously screened postmenopausal women: the Heart and Estrogen/progestin Replacement Study (HERS)
Alternate Title: Annals of internal medicine
Keywords: Humans; Aged; Female; Questionnaires; Predictive Value of Tests; Follow-Up Studies; Prospective Studies; Double-Blind Method; False Positive Reactions; Postmenopause; Estrogen Replacement Therapy; Vaginal Smears; Cervix Uteri; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia; Estrogens, Conjugated (USP); Medroxyprogesterone Acetate
Journal Title: Annals of internal medicine
Volume: 133
Issue: 12
ISSN: 0003-4819
Publisher: American College of Physicians--American Society of Internal Medicine  
Date Published: 2000
Start Page: 942
End Page: 950
DOI/URL:
Notes: BACKGROUND The benefits and risks of performing annual cervical smears on postmenopausal women are not well defined. The independent effect of hormone replacement therapy on development of cytologic abnormalities is unknown. OBJECTIVE To determine the positive predictive value of cervical smears in previously screened postmenopausal women and to determine the effect of oral estrogen plus progestin on incident cervical cytologic abnormalities. DESIGN Prospective cohort study (incidence) and randomized, double-blind, placebo-controlled trial (hormone therapy). SETTING 20 U.S. outpatient and community clinical centers. PARTICIPANTS 2561 women with a uterus and normal cytologic characteristics at baseline. INTERVENTIONS Annual smears; oral conjugated equine estrogens, 0. 625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, or identical placebo. MEASUREMENTS Incident cytologic abnormalities (atypical squamous cells of undetermined significance, atypical glandular cells of undetermined significance, low-grade squamous epithelial lesion, and high-grade squamous epithelial lesion) and final histologic diagnoses. RESULTS The incidence of new cytologic abnormalities in the 2 years following a normal smear was 110 per 4895 person-years (23 per 1000 person-years [95% CI, 18 to 27 per 1000 person-years]). Among the 103 women with known histologic diagnoses, one had mild to moderate dysplasia. The positive predictive value of any smear abnormality identified 1 year after a normal smear, therefore, was 0% (CI, 0% to 5.0%) (0 of 78 women); the positive predictive value of abnormalities found within 2 years was 0.9% (CI, 0.0% to 3.0%) (1 of 110 women). In hormone-treated compared with non-hormone-treated women, the incidence of cytologic abnormalities was nonsignificantly higher (relative hazard, 1.36 [CI, 0.93 to 1.99]), largely because of a nonsignificant 58% greater incidence of atypical squamous cells of undetermined significance (relative hazard, 1.58 [CI, 0.99 to 2.52]). CONCLUSIONS Because of a poor positive predictive value, cervical smears should not be performed within 2 years of normal cytologic results in postmenopausal women. Therapy with oral estrogen plus progestin does not significantly affect the incidence of cytologic abnormalities.
KUMC Authors
  1. Thomas Snyder
    20 Snyder