Emilia Alfonzo

Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population‐based national cohort study

ObjectiveTo study the risk of vaginal cancer among hysterectomised women with and without cervical intraepithelial neoplasia (CIN).DesignPopulation‐based national cohort study.Setting and populationAll Swedish women, 5 million in total, aged 20 and up, 1987–2011 using national registries.MethodsThe 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 measureVaginal cancer.ResultsWe 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).ConclusionsOur 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 abstractHigh risk of contracting vaginal cancer among hysterectomised women having prevalent CIN at surgery.

Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross‐sectional study

AbstractObjectiveTo evaluate the effectiveness and performance of Swedescore in the Swedish screening programme.DesignCross‐sectional register study.Setting and PopulationAll Swedish women aged over 18 years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015–20.MethodsColposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models.Main Outcome MeasuresCIN2+.ResultsA total of 11 317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0–1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0–1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88.ConclusionsSwedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See‐and‐treat at Swedescore 8–10 is feasible only if referral cytology showed high‐grade squamous intraepithelial lesion.Tweetable AbstractNo safe cutoff level for refraining from biopsy nor for see‐and‐treat with Swedescore.