Abstract
Background/AimCervical cancer incidence and mortality has decreased after introduction of national screening in Sweden, but women with drug use disorders (DUD) are less likely to participate in screening programs. We aimed to investigate cervical cancer incidence and mortality among women with DUD compared to the general female population in Sweden. MethodsWe conducted a cohort study based on Swedish national register data for the period January 1997–December 2015. Data was collected for 3,838,248 women aged 15–75 years of whom 50,858 had DUD. Adjusted hazard ratios (HRs) for incident and fatal cervical cancer were calculated for women with and without DUD using Cox regression analysis. ResultsDUD was significantly associated with incident cervical cancer (HR = 1.39, 95% confidence interval [CI] 1.39–1.61), but not fatal cervical cancer (HR = 1.25, 95% CI: 0.91–1.71), after adjusting for age, educational attainment, social welfare, region of residence, marital status and HIV infection. ConclusionWomen with DUD were thus identified as a risk group for incident cervical cancer, which calls for attention from clinicians and policy makers. It is possible that non-attendance in cancer screening and other healthcare seeking barriers may affect the risk of incident cervical cancer among women with DUD but more research on this topic is needed.
Highlights
Cervical cancer is the fourth most common female cancer globally [1], but relatively uncommon in Sweden [2] – a country with tax financed healthcare that is strongly subsidized for the individual [3]
Women with drug use disorders (DUD) were identified as a risk group for incident cervical cancer, which calls for attention from clinicians and policy makers
It is possible that non-attendance in cancer screening and other healthcare seeking barriers may affect the risk of incident cervical cancer among women with DUD but more research on this topic is needed
Summary
Cervical cancer is the fourth most common female cancer globally [1], but relatively uncommon in Sweden [2] – a country with tax financed healthcare that is strongly subsidized for the individual [3]. Since the introduction of cervical screening program in Sweden in the late 1950s, the incidence of cervical cancer has more than halved and its mortality has been substantially reduced [2,4]. Several non-drug-related factors, including under-utilization of cancer screening [9,10], unmet healthcare needs and barriers towards healthcare seeking [11,12], psychiatric comorbidity [13,14] and tobacco smoking [15,16] have been suggested to affect the substantial physical morbidity among people with DUD. Tobacco smoking and impaired immune response due to Human immunodeficiency virus (HIV) are overrepresented among people with DUD [8,15,16] and both tobacco smoking and HIV are wellknown risk factors for cervical cancer [17,18]
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