(RxWiki News) Pap smears are considered a huge success story in the medical world. These tests have helped to diagnose cervical cancers at earlier and more treatable stages. Pap tests also pick up precancerous cells.
Researchers have discovered that women who have been treated for precancerous cervical cells may have elevated risks of developing and dying from full-blown cervical or vaginal cancer later in life — particularly after the age of 60.
These researchers emphasized that while the risks were small, these findings suggest that these women may need to be screened for cervical cancer even into old age.
"Establish a cervical screening schedule with your doctor."
Björn Strander, MD, PhD, a consultant in the Department of Obstetrics and Gynecology at the University of Gothenburg in Sweden, led this research team that looked at the risk of cervical and vaginal cancer in women who had previously been treated for cervical intraepithelial neoplasia grade 3 (CIN3), a precancerous condition.
“Although the risk of cervical cancer is substantially reduced, it is not eliminated when precursor lesions are detected and treated and when women presumably participate in follow-up programs,” the researchers wrote.
To evaluate the cancer risks of women who had been treated for CIN3, Dr. Strander’s team reviewed data from the Swedish Cancer Registry. They analyzed information on 150,883 women, 1,089 of whom had a diagnosis of invasive cervical cancer and 302 of whom died of the disease. Additionally, 147 of the women studied had been diagnosed with vaginal cancer and 54 women had died of that disease.
The research team found that cancer risks increased in women over the age of 60 and 75 and among women who were older when they were treated for CIN3:
- Compared with the general population, cancer risks were doubled for women who had been treated for CIN3 three decades earlier.
- Cancer risks accelerated in former CIN3 patients starting at age 60 and then again over the age of 75, when incidence rates increased 100 for every 100,000 women.
- Women treated for CIN3 between the ages of 60 and 69 had a five-fold increased cancer risk compared to women treated for CIN3 between the ages of 30 and 39.
- Death rates also increased with age, according to the researchers.
“Women previously treated for CIN3 are at increased risk of developing and dying from cervical or vaginal cancer, compared with the general female population. The risk accelerates above age 60 years, suggesting a need for lifelong surveillance of these women,” the authors of this study wrote.
“The data also showed that the risk is additionally increased in women treated for CIN3 late in life,” they added.
“The main implication of this study,” according to the researchers, “is that women previously treated for CIN3 also need surveillance in old age, perhaps as long as it is practical to visit a physician or a nurse to take a smear. Emphasis should be placed on continued surveillance in old age, rather than on follow-up for a specified number of years after treatment the strategy suggested, for instance, in the new US guidelines.”
The Centers for Disease Control and Prevention (CDC) recommends Pap tests for all women between the ages of 21 and 65.
This study was published January 14 in BMJ.
This study was supported by the Halland County Scientific Board and the Swedish Cancer Society.
No conflicts of interest were disclosed.
