Can pre-malignant conditions of the cervix be cured?

Objectives:

To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3.

Design:

Prospective cohort study.

Setting:

Swedish cancer registry. PARTICIPANTS: All women in Sweden with severe dysplasia or cervical carcinoma in situ (e quivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132,493) contributing 2,315,724 woman years.

Main Outcome Measures:

Standardised incidence ratios with risk of cancer in the Swedish general female population as reference, and relative risks in multivariable log-linear regression model, with internal references.

Results:

Women with previous cervical intraepithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34, 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found, with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results.

Conclusions:

Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.

Please click on the required question.

• 1 What is the cervix?
• 2 What is a cervical polyp?
• 3 What is meant by cervical erosion (ectopy) and cervicitis?
• 4  What is the transformation zone?
• 5 What is a 'Paptest' (PAP test (cervical smear) test)
• 6  My PAP smear test (cervical smear) shows inflammation. Should I be worried?
• 7  What are cells and what is an abnormal (pre- malignant) cell?
• 8 My PAP smear test (cervical smear) shows abnormal cells. Does this mean that I have cancer?
• 9  What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?
• 10  What are the symptoms of pre-malignancy of the cervix?
• 11  What are benign and malignant tumours?
• 12  Why have I developed a pre-malignant condition of my cervix?
• 13  What is colposcopy?
• 14  What treatments are available for pre-malignant conditions of the cervix?
• 15  Can pre-malignant conditions of the cervix be cured?
• 16  How can I be re-assured that the pre-malignant changes will not recur?
• 17  How can we prevent carcinoma of the cervix?
• 18  Is there a reason to screen for HPV?
• 19  Support Groups.
• 20  Are there any support groups?

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.