Long‐term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia

Abstract

Invasive cancer of the cervix after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the incidence of invasive disease. The rate of invasive cervical or vaginal cancer following treatment for CIN in UK remains elevated for at least 8 years. The aim of our study was to determine from international data how long this rate remains elevated and whether the rate of invasive disease reflects the rate of posttreatment CIN. The aim was to determine why the rate of invasive disease does not fall. A search of Medline and a secondary search of cited references identified 1,848 articles referring to the success rate of the treatment of CIN. Only 26 cohorts from 25 articles met all the inclusion criteria. The policy in these was to perform at least annual smears. After the first year following treatment for CIN, the rate of invasive disease remained about 56 per 100,000 woman years until at least 20 years after treatment. This rate is~2.8 times greater than expected. In contrast, the risk of posttreatment CIN declined steadily with time to about 190 per 100,000 women in the 10th year. Although the posttreatment rate of CIN falls with time, the rate of invasive disease remains static. It seems likely that this is due to diminishing compliance with follow-up. Women should be encouraged to persevere with annual smears for at least 10 years after their treatment as this may offer them the best chance of detecting recurrence at a treatable stage. ' 2005 Wiley-Liss, Inc.Key words: cervical neoplasms; cervical intraepithelial neoplasia; treatment; follow-up; patient compliance Invasive cancer of the cervix occurring after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the overall incidence of invasive disease. In 1997, a multicentre UK study of 44,699 women years of followup after conservative treatment of CIN showed that the cumulative rate of invasion after 8 years was 5.8 per 1,000 women and that the rate remained the same throughout the 8-year period such that these women remained at~5 times greater risk than the general population.1 The second edition of the NHS Cervical Screening Programme Guidelines, 2 published in the same year, described the controversy surrounding the optimum duration of annual cytology testing after the treatment of CIN. It also referred to the importance of confirming that the rate of invasive disease did not fall and of investigating the reasons for this continuing high risk.The present study was commissioned by NHS Cervical Screening Programme to undertake an analysis of long-term follow-up studies of women treated for CIN. The first objective was to determine from international data how long the rate of invasive cervical or vaginal cancer following treatment for CIN remains elevated. The second objective was to establish whether the rate of invasive disease was a reflection of the rate of posttreatment CIN. The aim was to investigate the reasons for the continuing high risk of invasive dis...

Cervical intra-epithelial neoplasia in HIV-positive women after excision of transformation zone – does the grade change?

“…However, in patients treated for cervical intra-epithelial neoplasia (CIN), the risk of developing cancer is still 2.8 times greater than in the general population, and may be more in women with recurrent disease. 5 Studies show that the recurrence of CIN after treatment was between 20% and 65% in HIV-infected women. 6,7 We aimed to assess whether the cervical disease that occurs in HIV-infected women after treatment is of a different grade of disease compared with the histology results at presentation.…”

Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study

“…Despite this the changed patterns in therapy can help explain the trend over time, as the trend remained after adjustment for age in the multivariable regression model. One study looked at the influence of treatment modalities 4 but did not find any significant difference in recurrence of cervical intraepithelial neoplasia or incidence of cancer between women who had undergone hysterectomy and those who were treated by conservative methods. One weakness of the study, however, was the small number of women who had had a hysterectomy.…”

“…Although most women treated for high grade dysplasias are protected from invasive cervical cancer, reports have shown an increased risk for high grade dysplasia and for cervical cancer among treated women. [1][2][3][4][5] Knowledge about the risk of invasive cancer after treatment is important as a basis for follow-up programmes. Even with vaccination of young females against certain high risk types of human papillomavirus, surveillance after treatment of high grade cervical lesions will still be required for the foreseeable future.…”

Clinical investigation of the safety and efficacy of a cervical intraepithelial neoplasia treatment using a hyperthermia device that uses heat induced by alternating magnetic fields

“…It is grouped into three categories: CIN I (mild dysplasia), CIN II (moderate to marked dysplasia) and CIN III (severe dysplasia to carcinoma in situ). Treating high-grade (HG)-CIN reduces the incidence and mortality caused by invasive cervical cancer in women with these lesions (1)(2)(3). Women treated for CIN are of reproductive age (mean age of approximately 30 years), although the disorder may also arise in much younger women (4,5).…”