Healthcare Policy and Research has found that women who have been treated
for cervical intraepithelial neoplasia (abnormal cervical cell growth),
are at higher risk for a recurrence of the disease or invasive cervical
cancer.
The large, population-based study, which appears in the May 12 online
issue of the Journal of the National Cancer Institute, sheds new light on
the long-term risks of subsequent abnormal cell growth or invasive cancer,
and should help in the development of follow-up treatment guidelines for
women with a history of treatment for abnormal cells.
"We now have a much more clear idea of the risks of recurrent abnormal
cells and invasive cervical cancer over time after treatment of these
cells," said Joy Melnikow, Professor of Family and Community Medicine and
Associate Director of the UC Davis Center for Healthcare Policy and
Research, who led the study. "Recurrence risk depends on the grade of
abnormal cells that was initially treated, what treatment was used, and
the woman's age."
In the study, which used data from the British Columbia Cancer Agency
cytology database and was funded by a grant from the National Cancer
Institute, Melnikow and colleagues identified 37,142 women who were
treated for abnormal cells from Jan. 1, 1986 through Dec. 31, 2000.
They compared them with a group of 71,213 women with no previous diagnosis
of abnormal cells. Both groups were under active surveillance through
2004.
They found that risk of subsequent abnormal cells or cervical cancer was
associated with the type of treatment they received, their age, and the
initial grade of diagnosis. There are three levels of abnormal cervical
cells; grade 3 is the most severe. There is no standard treatment for
abnormal cells; at early stages, abnormal cells are monitored to determine
if they resolve without treatment.
At later stages, the type of treatment depends on several variables,
including the grade and distribution of the abnormal cells and whether the
patient has been treated previously.
According to the study, the risk of invasive cervical cancer and
recurrence of grade 2 or grade 3 abnormal cells was highest for women who
were older than 40, previously treated for grade 3, or treated with
cryotherapy, a common treatment method in which the abnormal cells are
frozen to stop their growth. Rates of recurrence at grades 2 and 3 were
lowest among women treated with cone biopsy, a method in which the
abnormal cells are removed surgically.
Melnikow said the findings could help guide physicians in making
recommendations about the intensity of follow up needed after treatment
for abnormal cells. In addition, she said the findings may help physicians
and patients in deciding which type of treatment for abnormal cells to
choose. She explained, for example, that while cryotherapy was associated
in the study with a higher risk of recurrence, it carries less risk of
other harmful effects than cone biopsy or loop electrical excision,
procedures which have been associated with pre-term delivery in women who
later become pregnant.
This suggests that a younger woman with grade 2 abnormal cells who plans
to start a family might opt for cryotherapy, while an older woman with
grade 3 abnormal cells who is at greater risk for recurrence might opt for
loop excision or cone biopsy.
"These data may help inform that treatment discussion, because we know
more about how age and different treatments appear to influence risks,"
Melnikow said.
The study also found that the highest rates of recurrence of abnormal
cells were observed in the first six years after treatment; the majority
of those were identified in the first two years. Recurrence rates for
grade 2 or grade 3 abnormal cells during the 6-year period ranged from 2.3
percent in the lowest risk group to 35 percent in the highest risk group.
Overall incidence of cervical cancer in the abnormal cell group was 37
cervical cancers per 100,000 woman-years, compared with six cervical
cancers per 100,000 woman-years among women not previously diagnosed.
Melnikow pointed out that the study also has different implications for
health policy depending on the health system and resources. In developing
countries where cervical cancer screening and treatment are more limited
and death rates higher for cervical cancer, cryotherapy, a simpler and
less expensive treatment method for abnormal cells, is likely to be
preferred.
Melnikow said the next step is to compare different treatment and
surveillance strategies in terms of cost-effectiveness.
Source
UC Davis Health System
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