Long-Term Risk for Noncervical Anogenital Cancer in Women with Previously Diagnosed High-Grade Cervical Intraepithelial Neoplasia: A Danish Nationwide Cohort Study

Sand, Freja Lærke; Munk, Christian; Jensen, Signe Marie; Svahn, Malene Frøsig; Frederiksen, Kirsten; Kjær, Susanne K.

doi:10.1158/1055-9965.epi-15-1291

Cited by 29 publications

(29 citation statements)

References 28 publications

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“…High grade lesions are characterized as cervical intraepithelial neoplasia(CIN) 2 and -3, and considered intermediate stages in the cancer progression, often developing within 5 years of infection with these high-risk HPV types [2]. Women with high-grade CIN have a long-term risk of not only cervical cancer, but also anal, vulvar, and vaginal cancers, when compared to the general population [3][4][5]. Additionally, a few studies have exposed an association between high-grade CIN and head and neck cancer [6,7].…”

Section: Introductionmentioning

confidence: 99%

Association between oropharyngeal cancers with known HPV and p16 status and cervical intraepithelial neoplasia: a Danish population-based study

et al. 2019

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Background: Persistent infection with high-risk genotypes of human papillomavirus (HPV) is the main risk factor in the development of uterine cervical precancerous lesions and cervical cancer (CC), and cases of HPV-induced oropharyngeal squamous cell carcinoma (OPSCC) is increasing in the Western world. We investigated the association between HPV and p16 status and previous results of cervical examinations, including cytological and histological tests, in females with OPSCC. Material and Methods: We included females diagnosed with an OPSCC in Eastern Denmark from 2000 to 2014. OPSCCs were assessed for p16-overexpression and HPV DNA PCR. History of cervical tests was obtained from the Danish Pathology Registry. The cytology and histological results were categorized in accordance with the 2014 Bethesda System (TBS) and WHO. Hence, we divide the cervical results into two groups. Group I were negative for intraepithelial lesion or malignancy and group II had epithelial cell abnormalities and subdivided after increasingly neoplastic severity from A-D. Chi 2tests and Fischer's exact tests were performed to compare the two groups. Results: A total of 417 women with OPSCC were identified; 203 with HPV-positive tumors (49%) of which cervical cytology or histology were available in 172 women (85%). Among these, 22 (13%) patients had a cervical history of ! IIC. A total of 171 out of 214 women in the HPV-negative group (80%) were examined with cytology and 17 had a history of ! IIC. No significant difference in diagnoses of (pre)cancerous lesions between the OPSCC HPV-positive and negative groups were observed (v 2 test p ¼ .28, Fischer's exact test p ¼ .29). Conclusion: HPV status in oropharyngeal tumors was not correlated with a history of ! IIC in cervical examinations. The effect on cervical dysplasia may be masked by a higher incidence of smoking among the OPSCC HPV-negative group. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Association between oropharyngeal cancers with known HPV and p16 status and cervical intraepithelial neoplasia: a Danish population-based study

et al. 2019

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“…Testing women with a history of cervical cancer for anal HPV and dysplasia clearly meets established appropriateness criteria for a potentially viable screening program [33] . Patients with a history of cervical neoplasia have been recently proven to represent a population at risk for persistent infection with oncogenic subtypes of HPV [34] . Similar to cervical cytologic testing [35] , simple anal sampling techniques can be used to simultaneously determine the presence of high risk HPV subtypes and to evaluate for evidence of dysplasia [36] .…”

Section: Discussionmentioning

confidence: 99%

Patients with newly diagnosed cervical cancer should be screened for anal human papilloma virus and anal dysplasia: Results of a pilot study using a STELLA computer simulation and economic model

Ehrenpreis

Smith²

2018

Papillomavirus Research

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BackgroundWomen with cervical cancer often have anal human papillomavirus (HPV) infection and anal dysplasia. However, effectiveness of anal HPV screening is unknown.MethodsA dynamic model was constructed using STELLA. Populations are represented as "stocks" that change according to model rates. Initial anal cytology in new cervical cancer patients, dysplasia progression and regression, cost of treating high-grade squamous intraepithelial lesions (HSIL), and lifetime costs for anal cancer care were extrapolated from the literature. Local costs of anal HPV testing and cytology were obtained. Outcomes included anal cancer rates, anal cancer deaths, screening costs and cancer care.ResultsBenefits in the screened group included reduction in anal cancers after three years and anal cancer deaths after four years. After 10 years, predicted costs per anal cancer prevented and anal cancer deaths were $168,796 and $210,057 and were $98,631 and $210,057 at 20 years. Predicted costs per quality of life year saved at 10 and 20 years were $9785 and $1687. Sensitivity analysis demonstrated cost-effectiveness of screening for a variety of cure rates HSIL with electrocautery.ConclusionScreening for anal HPV and treatment of anal HSIL in patients with cervical cancer is cost-effective, prevents anal cancer and reduces anal cancer deaths.

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“…For example, Sand et al 7 reviewed years 1978-2012 from a Danish registry study and identified 125 incident anal cancers from 104,155 women with CIN3 and 32 from 52,135 women with CIN2. The mean age of diagnosis of women with CIN3 and CIN2 was the same at 34 years.…”

Section: Cin3 and Cervical Cancer: Risk Factors For Anal Cancermentioning

confidence: 99%

“…In particular, the increased risk of anal cancer began at the time of CIN3 diagnosis (regardless of the age at diagnosis), increased to 6 per 100,000 at ages 40-49 to 24 per 100,000 from age 60 and older; in this cohort, the increased risk of anal cancer continued for over 25 years following CIN2,3 diagnosis. 7 …”

Section: Cin3 and Cervical Cancer: Risk Factors For Anal Cancermentioning

confidence: 99%

Anal cancer and anal cancer precursors in women with a history of HPV-related dysplasia and cancer

Stier

Chiao

2017

Seminars in Colon and Rectal Surgery

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The epidemiology of anal cancer in the U.S. has changed over the past 3 decades. During this period the incidence of anal cancer has increased among both men and women. Of note, women with a history of anogenital HPV infection are at higher risk than the general population for anal cancer. The increased risk ranged from increased incidence rate ratios ranging from 1.82 to 6.3 in women with a history of cervical cancer, to 4.2-16.4 in women with a history of prior cervical intraepithelial neoplasia 3 (CIN 3). In addition, studies describing screening women with a previous history of anogential HPV infection (including CIN 3) for anal HPV and anal pre-cancers demonstrate that the prevalence of anal HPV is measureable in this population. The prevalence of anal high grade squamous intraepithelial lesions (HSIL) in this population was relatively low, which may have been related to the fact that many of these studies had insufficient samples, and the numbers of patients undergoing HRA remain low. Future studies evaluating anal cancer screening strategies in this high-risk group are needed.

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Long-Term Risk for Noncervical Anogenital Cancer in Women with Previously Diagnosed High-Grade Cervical Intraepithelial Neoplasia: A Danish Nationwide Cohort Study

Cited by 29 publications

References 28 publications

Association between oropharyngeal cancers with known HPV and p16 status and cervical intraepithelial neoplasia: a Danish population-based study

Association between oropharyngeal cancers with known HPV and p16 status and cervical intraepithelial neoplasia: a Danish population-based study

Patients with newly diagnosed cervical cancer should be screened for anal human papilloma virus and anal dysplasia: Results of a pilot study using a STELLA computer simulation and economic model

Anal cancer and anal cancer precursors in women with a history of HPV-related dysplasia and cancer

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