Abstract
BackgroundAlthough local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population.Materials and methodsDesign: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. Data synthesis: Summary effects were estimated using random-effects models.OutcomesIncidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population.ResultsTwenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22–69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57–4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58–21.10; P < 0.001), vulvar (3.34, 2.39–4.67; P < 0.001), and anal cancer (5.11, 2.73–9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69–36.94; P = 0.073).ConclusionsWomen treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.
Highlights
The introduction of systematic call and recall screening programmes has resulted in a profound decrease in the incidence and mortality from cervical cancer.[1]
The aim of this review was to the estimate the absolute risk of developing or dying from cervical cancer, and HPVand non-human papillomavirus (HPV)-related malignancies after cervical intraepithelial neoplasia (CIN) treatment, and to further explore how this compares with the risk reported in the general population
Υχ υϋυ records idenƟfied in database searches: Medline, Embase, Central υχ τψτ publicaƟons excluded during Ɵtle and abstract review υχυ full text publicaƟons assessed for eligibility υτύ publicaƟons excluded ϊϋ follow-up not through registries ό mean/median follow-up < ω years υω absolute or relaƟve incidence of cancers aŌer treatment not given υ outcome not of interest υ exposure not of interest υ women with untreated CINυ might have been included υ incidence of pre-invasive and invasive disease not given separately ϊ overlapping ύ reviews/commentaries/editorials φφ publicaƟons fulfilling eligibility criteria included
Summary
The introduction of systematic call and recall screening programmes has resulted in a profound decrease in the incidence and mortality from cervical cancer.[1]. Despite increased surveillance, these women have been reported to have a higher risk of invasive cervical cancer than the general population for several years after treatment.4e8 The impact of different treatment methods (excisional or ablative) on the risk of future invasion remains largely unclear.
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