BMJ, doi: 10.1136/bmj.39363.471806.BE, (Published 24 October 2007)

Research

Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study

¹ Department of Obstetrics and Gynecology, Sahlgren's Academy, University of Gothenburg, SU/Östra sjukhuset, SE-416 85, Sweden, ² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Objective To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3.

Design Prospective cohort study.

Setting Swedish cancer registry.

Participants All women in Sweden with severe dysplasia or cervical carcinoma in situ (equivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132 493) contributing 2 315 724 woman years.

Main outcome measures Standardised incidence ratios with risk of cancer in the Swedish general female population as reference, and relative risks in multivariable log-linear regression model, with internal references.

Results Women with previous cervical intraepithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34, 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found, with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results.

Conclusions Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

At what age should cervical screening stop?

Björn Strander
BMJ 2009 338: b809. [Extract] [Full Text]

Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis

M Arbyn, M Kyrgiou, C Simoens, A O Raifu, G Koliopoulos, P Martin-Hirsch, W Prendiville, and E Paraskevaidis
BMJ 2008 337: a1284. [Abstract] [Full Text] [PDF]

Cervical intraepithelial neoplasia and higher long term risk of cancer

Guglielmo Ronco, Mario Giovanni Sideri, and Stefano Ciatto
BMJ 2007 335: 1053-1054. [Extract] [Full Text] [PDF]

Risk of cervical and other cancers after treatment of cervical intraepithelial neoplasia: retrospective cohort study

Ilkka Kalliala, Ahti Anttila, Eero Pukkala, and Pekka Nieminen
BMJ 2005 331: 1183-1185. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Melnikow, J., McGahan, C., Sawaya, G. F., Ehlen, T., Coldman, A. (2009). Cervical Intraepithelial Neoplasia Outcomes After Treatment: Long-term Follow-up From the British Columbia Cohort Study. JNCI J Natl Cancer Inst 101: 721-728 [Abstract] [Full text]  
• Wilkinson, E. J. (2009). Women With Cervical Intraepithelial Neoplasia: Requirement for Active Long-Term Surveillance After Therapy. JNCI J Natl Cancer Inst 101: 696-697 [Full text]  
• Strander, B. (2009). At what age should cervical screening stop?. BMJ 338: b809-b809 [Full text]  
• Arbyn, M, Kyrgiou, M, Simoens, C, Raifu, A O, Koliopoulos, G, Martin-Hirsch, P, Prendiville, W, Paraskevaidis, E (2008). Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 337: a1284-a1284 [Abstract] [Full text]  
• (2007). Elevated Cervical Cancer Risk Continues for Decades After CIN 3 Treatment. JWatch Women's Health 2007: 3-3 [Full text]  
• Ronco, G., Sideri, M. G., Ciatto, S. (2007). Cervical intraepithelial neoplasia and higher long term risk of cancer. BMJ 335: 1053-1054 [Full text]  

Online poll

Find out more>>