Call for long follow-up after CIN3 treatment

Researchers from Sweden say that women who have been treated for cervical precancer should receive lifelong follow-up, after finding that their risk for dying from vaginal or cervical cancer markedly increases after the age of 60 years.

And the study findings, published in the BMJ, also show that women of all ages previously treated for cervical intraepithelial neoplasia grade 3 (CIN3) have a significantly increased risk for death from invasive vaginal or cervical cancer compared with women in the general population.

Björn Strander (University of Gothenburg, Sweden) used national data from 1958 to 2008 including that on 150,883 women with CIN3 who were followed-up from the year after the initial diagnosis until 2009. Overall, there were 1236 invasive cancer diagnoses and 355 deaths from the disease.

The team found that women with CIN3 had a 2.39-fold greater incidence of invasive cancer during follow-up and a 2.35-fold greater risk for death from invasive cancer than women in the general population.

These risks increased with increasing age at diagnosis of CIN3 and also in attained age during follow-up, particularly beyond the age of 60 years. For example, women aged 60 to 69 years at CIN3 treatment had an incidence of invasive cancer 10.58 times that expected in the general population. Meanwhile, women with an attained age of 70 to 79 years at diagnosis of cervical or vaginal cancer had an incidence rate 4.28 times that expected in the general population and a mortality rate 4.44 times greater.

And, the results also showed that even over 25 years after initial CIN3 diagnosis, women still had around a twofold increased risk for dying from vaginal or cervical cancer than women in the general population.

Writing in an accompanying editorial, Marc Arbyn (Scientific Institute of Public Health, Brussels, Belgium) and colleagues explain that, recent concerns over the effects on future pregnancies, namely the risk for premature delivery, may have deterred colposcopists from more aggressive treatment of CIN. This could explain why women who had received local treatment more recently were also at greater risk for developing cervical or vaginal cancer, they suggest.

“Strander and colleagues’ study makes it clear that women who have been treated for a high grade intraepithelial cervical lesion, particularly those aged 50 years or more, require careful surveillance, and that measures should be taken to assure full compliance with follow-up.

“The data also underline the need for better standardisation and quality assurance in colposcopic practice to achieve an optimal balance between risk of cancer and obstetric safety,” they conclude.

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