Dysplasia and the natural history of cervical cancer: Early results of the Toronto cohort study

A sample of 176 808 Pap smears, taken from 70 236 women, was constructed from the records of a large cytopathology laboratory between 1962 and 1981. The prevalence of cervical dysplasia, based on the distribution of initial smear results, rose from 42.7 to 94.9 per 1000 during the study period. The relative risks (RR) for the manifestation of a malignancy (carcinoma in situ or worse) in a subsequent cervical smear were 1.48, 3.42, 20.9 and 71.5 for women with minimal, mild, moderate and severe dysplasia, respectively, compared with the entire cohort. The initial degree of dysplasia for women developing a malignancy was much more likely to be interpreted as moderate (RR = 5.0) or severe (RR = 42.3) than were those for controls. These results are strongly supportive of the hypothesis that the degree of dysplasia is related to the risk of development of cancer of the cervix.