Post-conization surveillance in an organized cervical screening program with more than 23,000 years of follow-up.

IF 3.1 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2023-12-06 DOI:10.1186/s13027-023-00545-4

Avalon Sundqvist, Johanna Nicklasson, Pernilla Olausson, Christer Borgfeldt

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引用次数: 0

Abstract

Background: Cervical cancer is preventable through screening and vaccination against high-risk human papillomavirus (hr-HPV). For a screening program to be successful it is vital that the clinical management and follow-up regime of patients with abnormal screening results is well developed and that the attendance rate for follow-up is high. The aim of the study was to analyze how effective conization with recommended follow-up was in preventing subsequent cervical cancer, and to evaluate how clinical follow-up recommendations are obeyed in the region of Skåne, Sweden.

Methods: All women (n = 8835) who had undergone conization in the region of Skåne, Sweden, between the years of 2015 and 2021 were identified. Individuals with confirmed cervical cancer in the conization material were referred for additional treatment (n = 114), leaving 8721 included in the follow-up. Adherence to follow-up and cytological, histopathological and HPV status at follow-up were collected at eight, 12 and 24 months post-conization. The total follow-up time was from January 1, 2015, to January 30, 2023.

Results: Within 12 months post-conization, 90% of the patients conducted a cytological cervical sample. The rates of a negative test of cure (HPV negative and normal cytology) were 69.7%, 76.3% and 84.4% at eight, 12 and 24 months post-conization respectively. The clearance of HPV was 79.6%, 80.8% and 87.8% at eight, 12 and 24 months post-conization respectively. Out of 5613 patients with a negative test of cure within one year after conization, no cervical cancer was found during follow-up and 11 (0.2%) women developed high-grade intraepithelial lesions/adenocarcinoma in situ (HSIL/AIS) with an average time from conization to new diagnosis of 42 months. The mean follow-up time was 32.1 months.

Conclusions: The clearance rate of hr-HPV post cervical conization due to dysplasia appears to be high within eight months. With a negative test of cure post cervical conization, the risk of cervical cancer within the following three years seems to be extremely low and the risk of developing HSIL/AIS was lower than the incidence of HSIL/AIS in the general screening population.

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在一个有组织的宫颈筛查项目中进行了超过23000年的随访。

背景:宫颈癌可通过筛查和接种高危人乳头瘤病毒(hr-HPV)预防。筛查项目要想取得成功，至关重要的是对筛查结果异常患者的临床管理和随访制度要完善，随访率要高。该研究的目的是分析锥体化与推荐随访在预防继发宫颈癌方面的有效性，并评估瑞典sk内地区的临床随访建议是如何被遵守的。方法:选取2015年至2021年间在瑞典sk内地区接受过锥形手术的所有女性(n = 8835)。在锥形材料中确诊为宫颈癌的个体被转介进行额外治疗(n = 114)，其余8721人被纳入随访。随访后8、12和24个月收集随访时的细胞学、组织病理学和HPV状态。总随访时间为2015年1月1日至2023年1月30日。结果:术后12个月内，90%的患者行宫颈细胞学检查。术后8个月、12个月和24个月的治愈阴性(HPV阴性和细胞学正常)率分别为69.7%、76.3%和84.4%。术后8个月、12个月和24个月HPV清除率分别为79.6%、80.8%和87.8%。在5613例根尖切除术后1年内治愈阴性的患者中，随访期间未发现宫颈癌，11例(0.2%)女性出现高级别上皮内病变/原位腺癌(HSIL/AIS)，从根尖切除术到新诊断的平均时间为42个月。平均随访32.1个月。结论:宫颈发育不良术后8个月内hr-HPV清除率较高。宫颈根治后检测为阴性的患者，其三年内发生宫颈癌的风险似乎极低，HSIL/AIS的发生风险低于一般筛查人群HSIL/AIS的发生率。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.