Risk of HPV-related extra-cervical cancers in women treated for cervical intraepithelial neoplasia

Abstract

Background The aim was to estimate the risk of subsequent extra-cervical Human Papillomavirus (HPV) related cancer in patients surgically treated for high grade cervical intraepithelial neoplasia (CIN 2–3). This is the first study in Italy investigating the occurrence of extra-cervical tumors in this cohort of patients. Methods 3184 patients surgically treated for CIN2–3 since 1992 at the Department of Surgical Sciences of University of Torino were considered. The risk of HPV-related cancer was calculated as Standardized Incidence Ratio (SIR), using as expected values tumour age specific incidence of resident population. Results 173 second primary cancer (SCPs) were identified. SIR to develop cancer after treatment for CIN2–3 was 2.2 (CI 95% 1.89–2.50). Among these occurrences, 10 are in HPV related sites: 1 anus (SIR = 1.8; 0.04–10.0), 3 vagina (SIR = 12.4; 2.56–36.3), 1 vulva (SIR = 1.7; 0.04–9.59), 5 oropharynx (SIR = 8.5; 2.76–19.8). Significant risk has been also recorded for pulmonary (SIR = 3.1; 0.70–5.27) and bladder (SIR = 4.05; 1.10–10.56), with smoking as possible cofactor. We also found increased risk for breast (SIR = 2.4; 2.07–2.84) and ovarian cancers (SIR = 2.1; 1.13–3.49), probably due to an higher adherence to spontaneous and programmed screening programs. Conclusions Our study supports the hypothesis of an increased risk of HPV-related tumours for CIN treated patients, mostly for CIN3. It is conceivable the need of early diagnosis for these cancers in this higher-risk populations.

New Insights into the Epidemiology of Vulvar Cancer: Systematic Literature Review for an Update of Incidence and Risk Factors

“…Studies encompassing lower grades of CIN, that is, CIN1-3 [ 55 , 56 ] or CIN2-3 [ 40 , 71 ], confirmed the above observations with a single exception, an Italian hospital-based cohort study of patients with CIN2-3 [ 71 ] in which the incidence increase was moderate and not significant. A study reported from the British Columbia associated a diagnosis of CIN2-3 with a SIR for VC of 2.90 [ 47 ].…”

“…The number of original articles selected was 63. Six more original articles were identified through snowballing for a total of 69 articles [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”

“…Four more studies considered the risk of VC for women with a history of CIN2-3 [ 47 , 71 ] and CIN1-3 [ 55 , 56 ]. Preti et al reported a moderate and nonsignificant risk increase for CIN2-3 patients [ 71 ].…”

Evaluation of Visual and Cytology Screening in Preventing Cervical Intraepithelial Neoplasia and Cervical Cancer in Namibia

“…Analysis further identi ed clinical presentation of chronic lower abdominal pain (speci cally in older women), indication of contraceptives, smoking and menopause. In fact, [15] describe smoking as the mutual risk factor and most plausible root of correlation between cervical and lung or bladder cancers as well as con rmed a formidable association between oral and cervical HPV related lesions in smoking patients than non-smokers. Data from a study by [16] showed the need to identify post-menopausal women at risk of developing CIN or cancer prior to completion of screening programme.…”

Upregulation of Translationally Controlled Tumor Protein Is Associated With Cervical Cancer Progression

“…As per the global cancer statistics, cervical cancer is ranked as the fourth most common cancer in women ( https://www.who.int/health-topics/cervical-cancer#tab = tab_1 ) ( Das, 2021 ). Diagnosis and treatment of the preinvasive lesions at cervical intraepithelial neoplasia (CIN) stages would render the disease curable (Castle et al, 2017 ) and possess tremendous importance in the cervical cancer control agenda ( Preti et al, 2020 ). Although the cervical cancer screening and prophylactic vaccination against HPV have achieved some success in prevention and early treatment in the most affluent countries, cervical cancer remains the leading cause of mobility and mortality for women in countries with inadequate health services and vaccination coverage ( Bray et al, 2018 ; Beddoe, 2019 ; Canfell et al, 2020 ).…”