Dutch Study Assesses Long-Term Risk of HPV-Related Carcinoma and Premalignancies After CIN3 Diagnosis


Key Points

  • Women with a previous CIN3 diagnosis were at increased risk for HPV-related carcinoma and premalignancy.
  • Risks were increased for anal, vulvar, and vaginal cancers and intraepithelial neoplasia grade 3 and for oropharyngeal cancer.

A Dutch study has shown long-lasting risk for human papillomavirus (HPV)-related carcinoma and premalignancies in women with a diagnosis of cervical intraepithelial neoplasia grade 3 (CIN3). The findings were reported by Ebisch et al in the Journal of Clinical Oncology.

Study Details

The population-based cohort study included women diagnosed with CIN3 between 1990 and 2010 from the Dutch nationwide registry of histopathology and cytopathology (n = 89,018) and a matched control group of women without CIN3 diagnosis (n = 89,018). Data on all cases of high-risk HPV-associated high-grade lesions and carcinomas in the anogenital region and oropharynx between 1990 and 2015 were extracted from the registry.

Increased Risks

Median follow-up was 14 years. A total of 299 HPV-related carcinomas and 634 HPV-related premalignancies were found during 1,261,804 person-years in women with a previous diagnosis of CIN3, and a total of 48 HPV-related carcinomas and 50 HPV-related premalignancies were found during 1,262,998 person-years in those without a previous diagnosis.

For women with a previous CIN3 diagnosis, incidence rate ratios were 6.24 for any HPV-related carcinoma, 12.75 for any HPV-related premalignancy, and 9.68 for any HPV-related carcinoma or premalignancy. Incidence rate ratios were 3.85 for anal cancer, 6.68 for anal intraepithelial neoplasia grade 3, 4.97 for vulvar cancer, 13.66 for vulvar intraepithelial neoplasia grade 3, 86.08 for vaginal cancer, 25.65 for vaginal intraepithelial neoplasia grade 3, and 5.51 for oropharyngeal cancer. Risk remained elevated through longer-term follow-up out to 20 years.

The investigators concluded: “This population-based study shows a long-lasting increased risk for HPV-related carcinomas and premalignancies of the anogenital and oropharyngeal region after a CIN3 diagnosis. Studies that investigate methods to prevent this increased risk in this group of patients, such as intensified screening or vaccination, are warranted.”

Renée M.F. Ebisch, MD, of Radboud University Medical Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.