Prevalence of squamous abnormalities in women with a recent smear without endocervical cells is lower as compared to women with smears with endocervical cells

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Abstract
The purpose of this study was to determine the prevalence rate ratio of squamous lesions in women with recent smears without endocervical component (ECC−) versus women having a smear with ECC+ and to estimate the true prevalence of these lesions in women with ECC− smears by addition of short‐term follow‐up results of negative ECC− smears. Results of initial smears in a 3‐year period, as well as follow‐up results of negative ECC− smears in the same period were retrieved. Women were categorized into two groups: having ECC− and ECC+ smears. The data were analysed for three outcome parameters, ASCUS or higher (ASCUS+), LSIL or higher (LSIL+) and HSIL or higher (HSIL+). Squamous abnormalities occurred far less frequently in women with initial ECC− than with ECC+ smears. Prevalence rate ratio (PRR) was 0.27 for ASCUS+, 0.39 for LSIL+ and 0.36 for HSIL+. Addition of follow‐up results of negative ECC− smears, as a correction for false‐negative ECC− smears, results in PRRs which are still significantly lower than 1, and most marked in subset HSIL+ (PRR = 0.60). We conclude that the true prevalence of squamous lesions in women with recent ECC− smears is significantly lower as compared with ECC+ smears. These findings lent support to the decision to abolish the repeat of ECC− smears in the Dutch population screening programme.