Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: A population‐based case–control study

Abstract

A substantial proportion of women with cervical cancer that have participated in cervical screening have a history of an abnormal cytology result. Our objective was to assess the impact of histological investigation and treatment of women with abnormal cytology on the subsequent risk of invasive cervical cancer. All invasive cervical cancer cases in Sweden 1999Sweden -2001 and five population-based control women per case were investigated. Clinical investigations and treatment were analysed in case women (N 5 143) and control women (N 5 176) below 67 with abnormal cytology results 0.5-6.5 years before the cases' diagnosis. Cervical cancer risk in relation to investigation [histology or not, punch biopsy, cervical curettage or cone/ large loop excision of the transformation zone (LLETZ)], and treatment (treatment or not, excisional or ablative) was estimated as odds ratios (ORs) using logistic regression. Absence of histological assessment was associated with increased cancer risk, both after low-grade [OR 2.37; 95% confidence intervals (CI): 1.27-4.43] and high-grade squamous atypia (8.26; 2.37-28.8). Among women with histology, absence of treatment was associated with increased cancer risk (3.68; 1.53-8.84), also when biopsy showed low-grade atypia or normal findings (3.57; 1.18-10.8). Ablative therapy associated with increased risk compared with excisional (3.82; 1.01-14.4), and laser conisation associated with decreased risk compared with LLETZ (0.06; 0.01-0.36). In conclusion, low-grade as well as high-grade squamous atypical cytology results may warrant histological investigation, treatment reduced cancer risk even when histology was negative or showed low-grade atypia indicating a need for improvements in the diagnosis of high-grade lesions, and laser conisation was the most effective treatment.Screening by cytology has been highly effective in reducing the incidence of invasive cervical cancer by the detection and removal of precursor lesions.

Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature

“…Seven additional studies met the inclusion criteria, 46 , 58 , 59 , 60 , 61 , 62 , 63 but were excluded from the main analysis because they presented duplicate results of the same population. Some data from the duplicate studies were used in the subgroup analyses.…”

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

“…All women with diagnosed CIN3 were considered to be treated, because CIN3 verified by biopsy is always treated in Swedish practice. Indeed, in an audit of the Swedish screening programme,17 there were no cases of untreated CIN3 found among the 1230 women diagnosed with cervical cancer in 1999-2002. We used the patients’ unique personal registration numbers to link their details to the Cancer Registry.…”

Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study

“…For women aged 28 years and older, however, colposcopy and biopsy conferred a lower risk and thus remain the gold standard for that age group. 3 Atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion represent the majority of cervical abnormalities diagnosed in cervical screening, each year affecting millions of women globally. 4,10 This significant burden of disease has led to intense discussions on how to best manage women in a manner compatible ASCUS, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion.…”

“…We previously showed that women with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion who were referred to colposcopy and biopsy had the greatest cervical cancer risk reduction. 3 This subsequently became the management policy in Sweden. 4 However, our previous study was not powered to analyze cancer risk by age group.…”