Objectives: 1. To determine the annual rate of interval squamous cance
r of the cervix after a negative Papanicolaou smear report. 2. To eval
uate the proportion of women with cervical cancer who received negativ
e cervical smear reports during the three years before the cancer diag
nosis.Design and setting: Objective 1. A prospective study of the inci
dence of squamous cervical cancer from 1990 to 1993 among women who re
ceived negative cervical smear results in Victoria in 1990. Objective
2. A retrospective audit of preceding cervical smear results from 1990
to 1993 in women diagnosed with cervical cancer in Victoria in 1993.
Results: The average interval cervical cancer rate was 2.54 squamous c
ancers per 100 000 women per year (95% confidence interval, 1.75-3.67)
during the first three years after a negative smear report. The inter
val cancer rate did not vary by age group nor by the endocervical stat
us of the negative smear report. Of the 233 cases of cervical cancer d
iagnosed during 1993, 56 women (24%) had negative cervical cytology re
ported during the preceding three years. The frequency of preceding ne
gative cervical cytology was greater for non-squamous cancer (22 women
[33%] from 66 cases) than for squamous cancer (34 women [20%] from 16
7 cases). Conclusion: The rate of interval cancer diagnosis is very lo
w compared with expected rates in the absence of screening, indicating
the effectiveness of the cervical screening program in Victoria.