Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population‐based national cohort study

Abstract

Objective To study the risk of vaginal cancer among hysterectomised women with and without cervical intraepithelial neoplasia (CIN). Design Population‐based national cohort study. Setting and population All Swedish women, 5 million in total, aged 20 and up, 1987–2011 using national registries. Methods The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non‐hysterectomised. Main outcome measure Vaginal cancer. Results We identified 898 incident cases of vaginal cancer. Women with prevalent CIN at hysterectomy and those with a history of CIN3/AIS had incidence rates (IR) of vaginal cancer of 51.3 (95% CI 34.4–76.5) and 17.1 (95% CI 12.5–23.4) per 100 000, respectively. Age‐adjusted IR‐ratios (IRRs) compared with hysterectomised women with benign cervical history were 21.0 (95% CI 13.4–32.9) and 5.81 (95% CI 4.00–8.43), respectively. IR for non‐hysterectomised women was 0.87 (95% CI 0.81–0.93) and IRR was 0.37 (95% CI 0.30–0.46). In hysterectomised women with prevalent CIN, the IR remained high after 15 years of follow up: 65.7 (95% CI 21.2–203.6). Conclusions Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non‐hysterectomised women in the general population. Still, the incidence rate does not justify screening. Tweetable abstract High risk of contracting vaginal cancer among hysterectomised women having prevalent CIN at surgery.

Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study

“…This risk remains elevated for at least 15 years. 21 From our data, this risk appears lower than expected, probably because follow‐up time is brief in some women. Only 2% of women appeared to have an HG‐VaIN, while less than 1% of cases revealed vaginal cancer, but the short follow‐up does not allow firm conclusions.…”

“… 9 , 15 , 16 , 17 , 18 , 19 , 20 Hysterectomized women with prevalent CIN have a 20‐fold increase in age‐adjusted risk, compared with hysterectomized women with benign cervical history, and the risk for hysterectomized women with a history of CIN3 is 15‐fold increased, compared to non‐hysterectomized women. 21 Therefore, in these women, practicing an unjustified hysterectomy could lead to a higher risk of subsequent vaginal cancer. This risk remains elevated for at least 15 years.…”

“…It is established that the risk of vaginal cancer or VaIN is significantly increased in women who have had a hysterectomy for cervical cancer or CIN compared to patients with other indications for hysterectomy 9,15–20 . Hysterectomized women with prevalent CIN have a 20‐fold increase in age‐adjusted risk, compared with hysterectomized women with benign cervical history, and the risk for hysterectomized women with a history of CIN3 is 15‐fold increased, compared to non‐hysterectomized women 21 . Therefore, in these women, practicing an unjustified hysterectomy could lead to a higher risk of subsequent vaginal cancer.…”

“…Some reports highlighted that the risk of vaginal cancer or vaginal intraepithelial neoplasia (VaIN) is significantly increased (5%–10%) in women who have had a hysterectomy for cervical cancer or CIN. 15 , 16 , 17 , 18 , 19 , 20 , 21 A recent study, 21 evaluating the outcome of a large cohort of Swedish patients undergoing hysterectomy for CIN, found an incidence rate of vaginal cancer of 51.3 per 100 000. The risk of vaginal cancer was increased after hysterectomy for women with benign cervical history as well (Incident Rates, IR 3.65).…”

Essentiality of Trace Elements in Pregnancy, Fertility, and Gynecologic Cancers—A State-of-the-Art Review

“…Additionally, chronic irritation is considered one of the main risk factors for the disease, especially in older women. High lifetime number of sexual partners, early age of the first intercourse, current smoking, history of cervical intraepithelial neoplasia (CIN), vaginal intraepithelial neoplasia, cervical carcinoma, and prior hysterectomy may also predispose women to vaginal cancer [ 78 , 79 , 80 , 81 ].…”