Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study

Abstract

ObjeCtivesTo investigate the risks of invasive cervical cancer after detection of atypical glandular cells (AGC) during cervical screening.Design Nationwide population based cohort study.setting Cancer and population registries in Sweden.PartiCiPants 3 054 328 women living in Sweden at any time between 1 January 1980 and 1 July 2011 who had any record of cervical cytological testing at ages 23-59. Of these, 2 899 968 women had normal cytology results at the first screening record. The first recorded abnormal result was atypical glandular cells (AGC) in 14 625, high grade squamous intraepithelial lesion (HSIL) in 65 633, and low grade squamous intraepithelial lesions (LSIL) in 244 168. Main OutCOMe MeasuresCumulative incidence of invasive cervical cancer over 15.5 years; proportion of invasive cervical cancer within six months of abnormality (prevalence); crude incidence rates for invasive cervical cancer over 0.5-15.5 years of follow-up; incidence rate ratios compared with women with normal cytology, estimated with Poisson regression adjusted for age and stratified by histopathology of cancer; distribution of clinical assessment within six months after the abnormality. resultsThe prevalence of cervical cancer was 1.4% for women with AGC, which was lower than for women with HSIL (2.5%) but higher than for women with LSIL (0.2%); adenocarcinoma accounted for 73.2% of the prevalent cases associated with AGC. The incidence rate of invasive cervical cancer after AGC was significantly higher than for women with normal results on cytology for up to 15.5 years and higher than HSIL and LSIL for up to 6.5 years. The incidence rate of adenocarcinoma was 61 times higher than for women with normal results on cytology in the first screening round after AGC, and remained nine times higher for up to 15.5 years. Incidence and prevalence of invasive cervical cancer was highest when AGC was found at ages 30-39. Only 54% of women with AGC underwent histology assessment within six months, much less than after HSIL (86%). Among women with histology assessment within six months, the incidence rate of cervical cancer after AGC was significantly higher than that after HSIL for up to 6.5 years.COnClusiOns AGC found at cervical screening is associated with a high and persistent risk of cervical cancer for up to 15 years, particularly for cervical adenocarcinoma and women with AGC at age 30-39. Compared with the reduction in risk of cancer seen after HSIL management, management of AGC seems to have been suboptimal in preventing cervical cancer. Research to optimise management is needed, and a more aggressive assessment strategy is warranted.

Determination of attitudes and behaviors towards early diagnosis of cervical cancer of first-degree relatives of women who receive treatment of cervical cancer

“…Therefore, they encounter early age pregnancies and excessive fertility problems. These problems increase the cervical cancer risk in the future (Kanbur & Capik, 2011;Guner & Taskiran, 2007;Kaya & Akin, 2009;Turkish Society of Gynecologic Oncology, 2017;American Cancer Society, 2017b, Ozgul, 2007Pinar et al, 2008;Lim et al, 2016;Wang et al, 2016;Niyazi et al, 2016). Pinar et al (2008) have found that 53.3% of the individuals with cervical cancer start their sexual intercourse at the age of 18 or younger.…”

“…Cervical cancer increases with the number of pregnancies and births. It has been reported that the fact that the number of pregnancies is more than three, and having the first pregnancy and childbirth before the age of 20 are important risk factors for the cervical cancer (Kanbur & Capik, 2011;Guner & Taskiran 2007;Kaya & Akin, 2009;Turkish Society of Gynecologic Oncology, 2017;American Cancer Society, 2017b;Ozgul, 2007;Lim et al, 2016;Wang et al, 2016;Niyazi et al, 2016). In the study of Pinar et al (2008), it has been shown that the majority of individuals with cervical cancer have the first pregnancy at the age of 18 or younger (51.1%) and most of them have more than 3 children at this age (86.7%).…”

“…Studies have shown that a significant proportion of women do not know the risk factors of cervical cancer and the importance of the Pap smear test. The fact that women do not know the risk factors and smear test may lead to inadequate use of methods related to the prevention, early diagnosis, and treatment (Ozgul, 2007;Wang et al, 2016;Magnusson et al, 2000; Ministry of Health, Public Health Department of Turkey, 2017b). Of the women, 59.7% of them stated that they did not have knowledge about cervical cancer, 78.4% of them stated that they did not know the aim of the Pap smear test, and 58.7% of them stated that they did not know about the Pap smear test and thus they did not have the test (Table 3).…”

“…Many of these risk factors are closely related to adverse health behaviors. The types of risky behaviors identified in the literature are: starting sexual intercourse at an early age (<16 years), having multiple sexual partners, having sex with a person with multiple sexual partners, being at the age of 20 or younger at the time of first pregnancy and delivery, having more than 3 pregnancies or deliveries at the age of 20 or younger, having sexually transmitted disease (especially HPV type 16-18, HSV II and HIV), cigarette use, being between 30 and 55 years of age, using of oral contraceptives over 5 years, overweight, low socioeconomic status, poor hygiene, early menarche, race (Black women), untreated other vaginal infections, abnormal vaginal bleeding, post-sexual bleeding, excessive vaginal discharge, and immunosuppression (Public Health Department of Turkey, 2017a; Kanbur & Capik, 2011;Guner & Taskiran 2007;Kaya & Akin, 2009;Ozgul, 2007;Taskin, 2016;Tuncer & Salman, 2004;Tuncer, 2004;Turkish Society of Gynecologic Oncology, 2017;American Cancer Society, 2017a;American Cancer Society, 2017b;Ozgul, 2007;Tarwireyi et al, 2003;Pınar et al, 2008;Lim et al, 2016;Wang et al, 2016;Niyazi et al, 2016).…”

Evolution of endocervical adenocarcinoma in situ: A retrospective case series study

“…AIS is the only known precursor to cervical adenocarcinoma and, in many cases, invasive disease can be prevented with appropriate management [1]. The usual interval between clinically detectable adenocarcinoma in situ and early invasion is reportedly at least five years, which provides a wide scope for detection and intervention [2,3]. Glandular neoplasia in the uterine cervix is less common than squamous neoplasia, being the second most frequent histological type of lesion in the cervix.…”