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Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population‐based national cohort study
Author(s) -
Alfonzo Emilia,
Holmberg Erik,
Sparén Pär,
Milsom Ian,
Strander Björn
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16028
Subject(s) - medicine , cervical intraepithelial neoplasia , gynecology , hysterectomy , cervical cancer , obstetrics , population , cohort , incidence (geometry) , cohort study , cancer , surgery , physics , environmental health , optics
Objective To study the risk of vaginal cancer among hysterectomised women with and without cervical intraepithelial neoplasia (CIN). Design Population‐based national cohort study. Setting and population All Swedish women, 5 million in total, aged 20 and up, 1987–2011 using national registries. Methods The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non‐hysterectomised. Main outcome measure Vaginal cancer. Results We identified 898 incident cases of vaginal cancer. Women with prevalent CIN at hysterectomy and those with a history of CIN3/AIS had incidence rates (IR) of vaginal cancer of 51.3 (95% CI 34.4–76.5) and 17.1 (95% CI 12.5–23.4) per 100 000, respectively. Age‐adjusted IR‐ratios (IRRs) compared with hysterectomised women with benign cervical history were 21.0 (95% CI 13.4–32.9) and 5.81 (95% CI 4.00–8.43), respectively. IR for non‐hysterectomised women was 0.87 (95% CI 0.81–0.93) and IRR was 0.37 (95% CI 0.30–0.46). In hysterectomised women with prevalent CIN, the IR remained high after 15 years of follow up: 65.7 (95% CI 21.2–203.6). Conclusions Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non‐hysterectomised women in the general population. Still, the incidence rate does not justify screening. Tweetable abstract High risk of contracting vaginal cancer among hysterectomised women having prevalent CIN at surgery.