Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: While 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 HPV- and non-HPV-related malignancies after CIN treatment and infer about its magnitude compared to general population.
Materials and methods:
Design: 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.
Outcomes: Incidence 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 with CIN versus the general population.
Results: Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100,000 woman-years (95% CI 22 to 69). RR of cervical cancer was elevated compared to the general population (3·30, 2·57 to 4·24; P<0·001). RR was higher for women over 50 years old and remained elevated for at least 20 years after treatment. RR of vaginal (10·84, 5·58 to 21·10; P<0·001), vulvar (3·34, 2·39 to 4·67; P<0·001), and anal cancer (5·11, 2·73 to 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 to 36·94; P=0·073).
Conclusions: Women treated for CIN have considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared to general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women above 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.
Materials and methods:
Design: 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.
Outcomes: Incidence 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 with CIN versus the general population.
Results: Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100,000 woman-years (95% CI 22 to 69). RR of cervical cancer was elevated compared to the general population (3·30, 2·57 to 4·24; P<0·001). RR was higher for women over 50 years old and remained elevated for at least 20 years after treatment. RR of vaginal (10·84, 5·58 to 21·10; P<0·001), vulvar (3·34, 2·39 to 4·67; P<0·001), and anal cancer (5·11, 2·73 to 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 to 36·94; P=0·073).
Conclusions: Women treated for CIN have considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared to general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women above 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.
Date Issued
2020-02
Date Acceptance
2019-11-04
Citation
Annals of Oncology, 2020, 31 (2), pp.213-227
ISSN
0923-7534
Publisher
Oxford University Press (OUP)
Start Page
213
End Page
227
Journal / Book Title
Annals of Oncology
Volume
31
Issue
2
Copyright Statement
© 2019 The Authors. Published by Elsevier Ltd on behalf of Eu-ropean Society for Medical Oncology. This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/).
Sponsor
Imperial College Healthcare NHS Trust
Identifier
https://www.sciencedirect.com/science/article/pii/S0923753419390854?via%3Dihub
Grant Number
RDD09 79560
Subjects
CIN
HPV-related cancer
LLETZ
cancer incidence
cancer mortality
conisation
Oncology & Carcinogenesis
1112 Oncology and Carcinogenesis
Publication Status
Published
Date Publish Online
2020-01-06