Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: a population-based case-control study.

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Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: a population-based case-control study.

Silfverdal, Lena, 1955- (author): Umeå universitet,Obstetrik och gynekologi

Kemetli, Levent (author)

Sparén, Pär (author): Karolinska Institutet

Andrae, Bengt (author): Uppsala universitet,Karolinska Institutet,Centrum för klinisk forskning, Gävleborg

Strander, Björn, 1952 (author): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology

Ryd, Walter, 1945 (author)

Dillner, Joakim (author): Karolinska Institutet

Törnberg, Sven (author): Karolinska Institutet

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(creator_code:org_t)

2010-12-09
2011
English.
In: International journal of cancer. - Malden : Wiley. - 1097-0215 .- 0020-7136. ; 129:6, s. 1450-8

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Journal article (peer-reviewed)

Abstract Subject headings

A substantial proportion of women with cervical cancer that have participated in cervical screening have a history of an abnormal cytology result. Our objective was to assess the impact of histological investigation and treatment of women with abnormal cytology on the subsequent risk of invasive cervical cancer. All invasive cervical cancer cases in Sweden 1999-2001 and five population-based control women per case were investigated. Clinical investigations and treatment were analysed in case women (N = 143) and control women (N = 176) below 67 with abnormal cytology results 0.5-6.5 years before the cases' diagnosis. Cervical cancer risk in relation to investigation [histology or not, punch biopsy, cervical curettage or cone/large loop excision of the transformation zone (LLETZ)], and treatment (treatment or not, excisional or ablative) was estimated as odds ratios (ORs) using logistic regression. Absence of histological assessment was associated with increased cancer risk, both after low-grade [OR 2.37; 95% confidence intervals (CI): 1.27-4.43] and high-grade squamous atypia (8.26; 2.37-28.8). Among women with histology, absence of treatment was associated with increased cancer risk (3.68; 1.53-8.84), also when biopsy showed low-grade atypia or normal findings (3.57; 1.18-10.8). Ablative therapy associated with increased risk compared with excisional (3.82; 1.01-14.4), and laser conisation associated with decreased risk compared with LLETZ (0.06; 0.01-0.36). In conclusion, low-grade as well as high-grade squamous atypical cytology results may warrant histological investigation, treatment reduced cancer risk even when histology was negative or showed low-grade atypia indicating a need for improvements in the diagnosis of high-grade lesions, and laser conisation was the most effective treatment.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Keyword

Adult
Biopsy
methods
Case-Control Studies
Conization
Disease Management
Early Detection of Cancer
Female
Humans
Neoplasm Invasiveness
Population Surveillance
Precancerous Conditions
diagnosis
therapy
Risk
Sweden
epidemiology
Uterine Cervical Neoplasms
diagnosis
epidemiology
pathology
Vaginal Smears
abnormal Pap smear results
Obstetrics and gynaecology
Epidemiology
MEDICINE

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Silfverdal, Lena ...; Kemetli, Levent; Sparén, Pär; Andrae, Bengt; Strander, Björn, ...; Ryd, Walter, 194 ...; show more...; Dillner, Joakim; Törnberg, Sven; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Obstetrics Gynae ...

Articles in the publication: International jo ...

By the university: University of Gothenburg; Umeå University; Karolinska Institutet; Uppsala University

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