Effect of ageing on cervical or vaginal cancer in Swedish women previously treated for cervical intraepithelial neoplasia grade 3: population based cohort study of long term incidence and mortality

Abstract

Objective To determine factors influencing long term risks for acquiring or dying from invasive cervical or vaginal cancer in women previously treated for cervical intraepithelial neoplasia grade 3 (CIN3).Design Population based cohort study conducted in 1958-2008, followed up until 2009 in the Swedish Cancer Registry and Swedish Cause of Death Register, linked to the Swedish Population Register. Standardised incidence and mortality ratios were calculated for the risk of acquiring or dying from vaginal or cervical cancer, with the general female population in Sweden as reference. Relative risks in multivariable regression models were also calculated, adjusting for follow-up duration, treatment period, and age at CIN3 treatment or attained age.Setting Entire female population of Sweden.Participants 150 883 women in Sweden diagnosed and treated with CIN3 and followed up for invasive cervical or vaginal cancer, and related mortality. The cohort comprised 3 148 222 woman years.Main outcome measures Standardised incidence and mortality ratios, stratified by period for treatment. Relative standardised incidence ratios and standardised mortality ratios for age at acquiring or dying from cervical or vaginal cancer (attained age), adjusted for preset variables.Results Women previously diagnosed with CIN3 had an increased risk of dying from invasive cervical or vaginal cancer, compared with the general female population (standardised mortality ratio 2.35, 95% confidence interval 2.11 to 2.61). After age 60 years, these women had an accelerated increased risk of acquiring invasive cancer; a similar steep increase in mortality risk was seen after age 70. Regression analyses indicated that the increase in risk over time is highly attributable to ageing.Conclusions Women previously treated for CIN3 are at increased risk of developing and dying from cervical or vaginal cancer, compared with the general female population. The risk accelerates above age 60 years, suggesting a need for lifelong surveillance of these women.

Epidemiological study of high‑risk human papillomavirus infection in subjects with abnormal cytological findings in cervical cancer screening

“…A recent study demonstrated that in a susceptible population, the 9vHPV vaccine prevented diseases associated with HPV31, -33, -45, -52 and -58, led to the production of antibodies against HPV6, -11, -16 and -18 and did not perform worse than the qHPV vaccine (33). HPV typing revealed the genotype distribution in the region, which may provide scientific evidence for future screening and vaccine development.…”

Primary vaginal cancer: role of MRI in diagnosis, staging and treatment

“…[5][6][7] In fact, higher rates of vaginal cancer are observed in patients with a previous diagnosis of cervical cancer or cervical intraepithelial neoplasia. 7,8 As is true for other gynaecologic malignancies, vaginal cancer diagnosis and staging rely primarily on clinical evaluation by the International Federation of Gynecology and Obstetrics (FIGO). 9 Pelvic examination continues to be the most important tool for evaluating local extent of disease, but this method alone is limited in its ability to detect lymphadenopathy and the extent of tumour infiltration.…”

Long term outcomes for women treated for cervical precancer

“…1 These findings are confirmed by Strander and colleagues (doi:10.1136/ bmj.f7361) in a trend analysis that linked data from pathology, cancer, and cause of death registries that have covered the whole Swedish population for more than half a century. 2 The authors report that the risk of developing or dying from cervical or vaginal cancer in women with a history of treatment for CIN3 (cervical intraepithelial neoplasia grade 3) is two to three times higher than in the general population. Furthermore the increase in risk among women treated for CIN3 rises significantly with older age and more recent year of treatment.…”

“…2 The authors suggest that the use of less aggressive treatments in the two most recent decades may have adversely affected oncological outcomes. The trend in treatment was driven by an increasing awareness that extensive procedures are associated with poor reproductive outcomes.…”

“…4 It is worrying that Strander and colleagues found that women who received local treatment more recently were at greater risk of developing cervical and vaginal cancer. 2 The authors suggest that the use of less aggressive treatments in the two most recent decades may have adversely affected oncological outcomes. The trend in treatment was driven by an increasing awareness that extensive procedures are associated with poor reproductive outcomes.…”