Photo Credit: Mayo Clinic

According to Qing Shen, PhD, researcher in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm “Cervical cancer screening is one of the most successful cancer prevention programs which has greatly reduced cervical cancer incidence and mortality,”

“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.” She added.

Prior research directed by Shen and colleagues proved an increased risk of injuries during the time 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 explained.

“Whether there is a similar increase in risk among patients screened for cervical cancer, when an organized cancer screening program was largely accessible, was unknown” she added.

The research was conducted with data from the Swedish Total Population Register, the researchers pointed out more than 3 million women who partook in cervical cancer screening during 2001-2012. Cross-linkage with numerous Swedish registries enabled for the identification of women within this cohort who obtained a diagnosis of invasive cervical cancer, cervical cancer precursor lesions, or had a normal smear during follow-up. The final cohort comprised approximately 1.85 million women with a normal smear, approximately 22,000 women with cervical intraepithelial neoplasia (CIN) grade 1, roughly 21,000 women with CIN2, roughly 37,000 with CIN3/adenocarcinoma in situ (AIS), and roughly 5,000 women with invasive cervical cancer.

The researchers assessed the incidence of injuries during the diagnostic workup of patients who partook in cervical cancer screening. From women with precursor lesions or cervical cancer, the diagnostic workup was clarified as the duration between the first Pap smear or punch biopsy until surgical treatment, or two months after the last smear or punch biopsy, if not treated surgically. From women with normal smear results, the diagnostic workup was clarified as the two months following the smear.

The researchers evaluated incidence proportions of both iatrogenic injuries and non-iatrogenic injuries that happened during the diagnostic workup. Iatrogenic injuries, which were primarily applicable to receipt of a punch biopsy, and which needed at least two days of hospitalization, were comprised in this analysis. Non-iatrogenic injuries, which comprised accidents and willful self-harm, and which needed a minimum of one day of hospitalization, were comprised. Incidence proportion ratios for injuries that happened during the diagnostic workup, which were evaluated by connecting women with a diagnosis of cervical cancer or its precursor lesions with women with a normal smear, were modified for age, calendar period, screening adherence, education, income, and marital status.

When the women with a normal smear were compared with women with a diagnosis of invasive cervical cancer, the women with a normal smear had eight times the incidence of iatrogenic injuries, and women with CIN3/AIS had three times the incidence of iatrogenic injuries. Women with CIN1-2 did not have a relatively increased rate of iatrogenic injuries 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 explained.

“An increase in non-iatrogenic injuries points to high levels of psychological distress in relation to receiving a diagnosis of cervical cancer,” said Shen.

“This study for the first time systematically examined the risks of injuries during the cervical diagnostic workup. Although the chance of having such injuries was rare, we found an increased risk of inpatient care for iatrogenic and non-iatrogenic 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.” The authors said.

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