title: Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study.
abstract: OBJECTIVE
  To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Swedish cancer registry.
  
  
  METHODS
  All women in Sweden with severe dysplasia or cervical carcinoma in situ (equivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132,493) contributing 2,315,724 woman years.
  
  
  METHODS
  Standardised incidence ratios with risk of cancer in the Swedish general female population as reference, and relative risks in multivariable log-linear regression model, with internal references.
  
  
  RESULTS
  Women with previous cervical intraepithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34, 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found, with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results.
  
  
  CONCLUSIONS
  Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgren's Academy, University of Gothenburg, SU/Ostra sjukhuset, SE-416 85, Sweden. bjorn.strander@oc.gu.se
authors.forename: Björn
authors.initials: B
authors.lastname: Strander
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson-Ellström
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000628:therapy*