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Cervical screening and risk of adenosquamous and rare histological types of invasive cervical carcinoma: population based nested case-control study
Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden.ORCID iD: 0000-0002-4718-1414
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm.
Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden.
Karolinska Inst, Dept Lab Med, S-14183 Stockholm, Sweden.
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2019 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1207Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

To examine the association of cervical cytology screening with the risk of adenosquamous cell carcinoma (ASC) and rare histological types of invasive cervical carcinoma (RICC), using comprehensive registry data, and to assess tumour human papillomavirus status of ASC and RICC.

DESIGN

Nationwide, population based, nested case-control study.

SETTING

Sweden.

PARTICIPANTS

All cases of invasive cervical carcinoma in Sweden during 2002-11 (4254 confirmed cases after clinical and histopathological review). 338 cases were neither squamous cell carcinoma nor adenocarcinoma, including 164 cases of ASC and 174 cases of RICC (glassy cell carcinoma, clear cell carcinoma, small cell carcinoma, neuroendocrine cell carcinoma, large cell carcinoma, and undifferentiated carcinoma). 30 birth year matched controls from the general Swedish population were matched to each case by applying incidence density sampling.

MAIN OUTCOME MEASURES

Conditional logistic regression was used to calculate odds ratios, interpreted as incidence rate ratios, for risk of ASC and RICC in relation to screening status and screening history, adjusted for education. Human papillomavirus distribution of ASC and RICC was based on available archival tumour tissues from most Swedish pathology biobanks.

RESULTS

Women with two screening tests in the previous two recommended screening intervals had a lower risk of ASC (incidence rate ratio 0.22, 95% confidence interval 0.14 to 0.34) and RICC (0.34, 0.21 to 0.55), compared with women without any test. High risk human papillomavirus was detected in 148/211 (70%) cases with valid human papillomavirus results from tumour tissues. The risk reduction among women with tumours that were positive (incidence rate ratio 0.28, 0.18 to 0.46) and negative (0.27, 0.13 to 0.59) for high risk human papillomavirus was similar, compared with women who did not attend any test.

CONCLUSIONS

Cervical screening is associated with reduced risk of ASC and RICC, and most ASC and RICC are positive for high risk human papillomavirus. This evidence provides a benchmark for evaluating future cervical screening strategies.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP , 2019. Vol. 365, article id l1207
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-382566DOI: 10.1136/bmj.l1207ISI: 000464005200002PubMedID: 30944091OAI: oai:DiVA.org:uu-382566DiVA, id: diva2:1313379
Funder
Swedish Foundation for Strategic Research , KF10-0046Swedish Foundation for Strategic Research , RB13-0011Swedish Research Council, 2014-03732Swedish Research Council, 2017-02346Swedish Cancer Society, 11 0569Swedish Cancer Society, 14 0665Swedish Cancer Society, 16 0699Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved

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