The clinical relevance of the lack of endocervical cells was never well established in a longitudinal study with histologically proven cervical cancer as an end point. From the Dutch Network and National Database for Pathology, results for all negative smears obtained in 1990 and 1991 in the Netherlands were retrieved, as were data for all cytologic and histologic examinations performed after the negative smears before April 1998. There were no significant differences between the proportion of preinvasive lesions (cervical intraepithelial neoplasia 1, 2, and 3) detected after negative smears without endocervical cells compared with negative smears with endocervical cells. The proportion of women in whom invasive cancer developed was the same in both groups. These data suggest there is no reason to advise women with negative smears without endocervical cells to undergo an additional smear.