Women With Cervical Cancer May Have Increased Risk of Injury During Diagnostic Workup

In a recent study conducted in Sweden, researchers found that women who were diagnosed with invasive cervical cancer had an increased risk of iatrogenic injuries, which are injuries that occur as a result of medical intervention, and noniatrogenic injuries, which occur due to accidents and self-harm.

The correlation was observed through the analysis of data from approximately 3 million women who had participated in cervical cancer screenings during the period of 2001 to 2012. By cross referencing multiple Swedish registries, the researchers were able to identify women within this cohort who received a diagnosis of invasive cervical cancer or cervical cancer precursor lesions, as well as women who had a normal smear during follow-up examination.

"Cervical cancer screening is one of the most successful cancer prevention programs, [and] has greatly reduced cervical cancer incidence and mortality," said Qing Shen, PhD, researcher in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, in a prepared statement. "Despite these substantial benefits, our research indicates that women with invasive cervical cancer experienced medical complications and psychological stress during their diagnostic workup, although at a very low level."

In prior research, Shen and her colleagues had found the potential for increased risk of injuries to be demonstrated during the time period before and after a diagnosis of any cancer.

"These injuries were likely a result of invasive procedures and the severe psychological distress experienced during the clinical evaluation of a potential cancer," Shen said in the press release. She additionally noted that what remains unknown is whether there would be a similar increase in risk among patients screened for cervical cancer if an organized cancer screening program was largely accessible.

After analysis of the initial 3 million women who had participated in cervical cancer screenings, the final cohort of women included in the study were approximately 1.85 million women with a normal smear, approximately 22,000 women with cervical intraepithelial neoplasia (CIN) grade 1, approximately 21,000 women with CIN grade 2 (CIN2), approximately 37,000 with CIN grade 3 (CIN3)/adenocarcinoma in situ (AIS), and approximately 5000 women with invasive cervical cancer.

The researchers then investigated the incidence rates of both iatrogenic injuries and noniatrogenic injuries that had occurred during the diagnostic workup. They found that the Iatrogenic injuries were frequently related to receipt of a punch biopsy, while noniatrogenic injuries were most frequently the result of unintentional falls.

For those injuries that occurred during the diagnostic workup, incidence rate ratios were found through comparing women with a diagnosis of cervical cancer or its precursor lesions to women who had a normal smear, with adjustments made for age, calendar period, screening adherence, education, income, and marital status.

The results of the research showed that women with a diagnosis of invasive cervical cancer, when compared with women with a normal smear, had 8 times the likelihood of iatrogenic injuries, while women with CIN3/AIS had a 3 times increased likelihood of iatrogenic injuries. However, women with CIN1-2 did not have a significantly increased rate of iatrogenic injuries when compared with women with a normal smear.

"Women with invasive cancer can have greater vascularity due to tumor growth, which can lead to hemorrhage and hematoma following a biopsy," Shen said.

Additionally, the results showed that women with a diagnosis of invasive cervical cancer had about twice the likelihood of noniatrogenic injuries than women with a normal smear. However, women with CIN1-2, CIN3, or AIS did not have a significantly increased rate of noniatrogenic injuries when compared with women with a normal smear.

"This study, for the first time, systematically examined the risks of injuries during the cervical diagnostic workup,” Shen said. “Although the chance of having such injuries was rare, we found an increased risk of inpatient care for iatrogenic and noniatrogenic injuries for women with invasive cervical cancer. It is important to emphasize, however, that cervical cancer screening is greatly beneficial for the early detection of cancer and is largely safe."

REFERENCE

Women with cervical cancer may have increased risk of injury during diagnostic workup. Philadelphia, PA: American Association for Cancer Research; October 21, 2020. eurekalert.org/pub_releases/2020-10/aafc-wwc101920.php. Accessed January 8, 2020.