Long-term risk of cervical cancer following conization of cervical intraepithelial neoplasia grade 3: A Danish nationwide cohort study

TY - JOUR

T1 - Long-term risk of cervical cancer following conization of cervical intraepithelial neoplasia grade 3

T2 - A Danish nationwide cohort study

AU - Sand, Freja Laerke

AU - Frederiksen, Kirsten

AU - Munk, Christian

AU - Jensen, Signe Marie

AU - Kjaer, Susanne K

N1 - © 2017 UICC.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Using nationwide Danish registries we examined the long-term risk of cervical cancer in women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (including adenocarcinoma in situ (AIS)) on the cone compared to women with a normal cytology test. Initially, we identified women born 1918-1990, who were recorded as living in Denmark between January 1, 1978 and December 31, 2012. From the Pathology Data Bank information on CIN3 on the cone, margins status, histological type of CIN3 and cervical cytology results was extracted. Cox proportional hazard model was used to estimate the relative risk of subsequent cervical cancer. We included 59,464 women with CIN3 on the cone and 1,918,508 women with a normal cytology test. Overall, women diagnosed with CIN3 had a higher risk of subsequent cervical cancer compared to women with normal cytology (HR = 2.06; 95%CI: 1.81-2.35). Analyses according to time since conization showed elevated risks in all time periods, and 25 years or more after conization the relative risk was significantly increased (HR = 2.56; 95%CI: 1.37-4.77). Twenty years or more after conization, also women with negative margins had an increased relative risk (HR = 2.49; 95%CI: 1.12-5.57). In addition, the long-term relative risk of cervical cancer varied with the different histological types of CIN3 and was highest for AIS (HR = 7.50; 95%CI: 1.87-30.01, 10-14 years after conization). In conclusion, women diagnosed with CIN3 on the cone have a long-lasting increased risk of cervical cancer even when the margins on the cone are negative.

AB - Using nationwide Danish registries we examined the long-term risk of cervical cancer in women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (including adenocarcinoma in situ (AIS)) on the cone compared to women with a normal cytology test. Initially, we identified women born 1918-1990, who were recorded as living in Denmark between January 1, 1978 and December 31, 2012. From the Pathology Data Bank information on CIN3 on the cone, margins status, histological type of CIN3 and cervical cytology results was extracted. Cox proportional hazard model was used to estimate the relative risk of subsequent cervical cancer. We included 59,464 women with CIN3 on the cone and 1,918,508 women with a normal cytology test. Overall, women diagnosed with CIN3 had a higher risk of subsequent cervical cancer compared to women with normal cytology (HR = 2.06; 95%CI: 1.81-2.35). Analyses according to time since conization showed elevated risks in all time periods, and 25 years or more after conization the relative risk was significantly increased (HR = 2.56; 95%CI: 1.37-4.77). Twenty years or more after conization, also women with negative margins had an increased relative risk (HR = 2.49; 95%CI: 1.12-5.57). In addition, the long-term relative risk of cervical cancer varied with the different histological types of CIN3 and was highest for AIS (HR = 7.50; 95%CI: 1.87-30.01, 10-14 years after conization). In conclusion, women diagnosed with CIN3 on the cone have a long-lasting increased risk of cervical cancer even when the margins on the cone are negative.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cervical Intraepithelial Neoplasia/epidemiology

KW - Cohort Studies

KW - Conization/adverse effects

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Middle Aged

KW - Neoplasm Grading

KW - Proportional Hazards Models

KW - Registries

KW - Uterine Cervical Neoplasms/epidemiology

KW - Young Adult

U2 - 10.1002/ijc.31202

DO - 10.1002/ijc.31202

M3 - Journal article

C2 - 29218720

SN - 0020-7136

VL - 142

SP - 1759

EP - 1766

JO - Radiation Oncology Investigations

JF - Radiation Oncology Investigations

IS - 9

ER -