Long-term mortality in women treated for cervical intraepithelial neoplasia.
OBJECTIVE
The objective of this study was to study whether women surgically treated for cervical intraepithelial neoplasia (CIN) have increased mortality later in life. We also wanted to study whether pregnancy beyond 22 weeks post-treatment affects the risk.


METHODS
Register-based retrospective cohort study from Finland.


METHODS
National data of the Hospital Discharge Register and the Cause-of-Death Register during 1986-2003.


METHODS
A total of 25 827 women who had surgical treatment for CIN during 1986-2003.


METHODS
We calculated standardised mortality ratios (SMRs) by dividing the numbers of observed deaths (until 31 December 2006) by the numbers of expected deaths.


METHODS
SMRs for different causes-of-death groups.


RESULTS
The overall mortality increased by 17% after treatment for CIN, including increased risk of dying from all diseases and medical conditions (SMR 1.13, 95% CI 1.01-1.26), cancers (SMR 1.09, 95% CI 0.91-1.27) and injury deaths (SMR 1.31, 95% CI 1.03-1.58). As expected, the mortality from cervical cancer was high (SMR 7.69, 95% CI 4.23-11.15). Women who had delivered post-treatment tended to have decreased overall mortality (SMR 0.78, 95% CI 0.52-1.04) and decreased disease mortality (SMR 0.63, 95% CI 0.37-0.90). However, the mortality rate was significantly increased for women who had subsequent preterm delivery (SMR 2.51, 95% CI 1.24-3.78). In this subgroup, there was a tendency of increased mortality from diseases of the circulatory system, alcohol-related causes and injury deaths.


CONCLUSIONS
Mortality rate was increased after surgical treatment for CIN. However, women who had delivered post-treatment had decreased overall disease mortality rate. Subsequent preterm delivery may be a risk marker for increased long-term mortality.
Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland. maija.jakobsson@fimnet.fi
M
M
Jakobsson
M
M
Gissler
J
J
Paavonen
A-M
AM
Tapper
D000059:Accidents / Q000401:mortality; D000293:Adolescent; D000328:Adult; D019973:Alcohol-Related Disorders / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011247:Pregnancy; D047928:Premature Birth; D013405:Suicide / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000401:mortality* / Q000601:surgery