Risk for injuries increases during diagnostic workup of cervical cancer
Click Here to Manage Email Alerts
Women with invasive cervical cancer demonstrated increased risks for iatrogenic and noniatrogenic injuries during diagnostic workup, according to results of a study published in Cancer Epidemiology, Biomarkers & Prevention.
Although the overall incidence of injury was rare, the increased rate of iatrogenic injuries — or those that are a consequence of medical intervention — and noniatrogenic injuries, which include accidents and self-harm, during the diagnostic workup of invasive cervical cancer underscore the burden of medical complications and the psychologic distress a woman may face when receiving a cancer diagnosis, according to the researchers.
“Cervical cancer screening is one of the most successful cancer prevention programs which has greatly reduced cervical cancer incidence and mortality,” Qing Shen, PhD, researcher in the department of medical epidemiology and biostatistics at Karolinska Institute in Sweden, said in a press release. “Despite these substantial benefits, our research indicates that women with invasive cervical cancer experienced medical complications and psychological stress during their diagnostic workup.”
Previous studies have shown an increased risk for injuries around the time of cancer diagnosis. Shen and colleagues sought to determine whether there are similar risks around the diagnosis of cervical cancer and its precursor lesions by evaluating the rate of hospitalization for iatrogenic or noniatrogenic injuries during the diagnostic workup.
The analysis included 3,016,307 Swedish women screened for cervical cancer between 2001 and 2012. Of them, 22,435 had cervical intraepithelial neoplasia grade 1 (CIN1), 20,692 had CIN2, 36,542 had CIN3/adenocarcinoma in situ (AIS) and 5,189 had invasive cervical cancer.
In total, 42 iatrogenic injuries that required at least a 2-day hospital stay occurred during the diagnostic workup of women with a cervical cancer diagnosis.
Compared with women with normal smears, researchers found an increased rate of iatrogenic injuries during the diagnostic workup of women with invasive cervical cancer (incidence rate [IR] = 0.58 per 1,000 person-months; IR ratio [IRR] = 8.55; 95% CI, 3.69-19.8) as well as for women with CIN3/AIS (IR = 0.09 per 1,000 person-months; IRR = 3.04; 95% CI, 1.73-5.34). The most common of these injuries included hemorrhage or hematoma and infections.
“Women with invasive cancer can have greater vascularity due to tumor growth, which can lead to hemorrhage and hematoma following a biopsy,” Shen said.
Researchers also observed 91 noniatrogenic injuries that required at least 1 day of hospitalization, the most common of which were unintentional injuries. Results showed an increased rate of noniatrogenic injuries during the diagnostic workup of women with invasive cancer (IR = 0.65 per 1,000 person-months; IRR = 2.48; 95% CI, 1.3-4.74), but not CIN2 or CIN3/AIS.
A lack of information on nonsurgical treatments, including palliative care, chemotherapy and radiotherapy for women with invasive surgical cancer, served as a limitation to this study because researchers had to assume the diagnostic period ended 2 months after the last biopsy.
“This study for the first time systematically examined the risks of injuries during the cervical diagnostic workup,” Shen said. “Although the chance of having such injuries was rare, we found an increased risk of inpatient care for iatrogenic and noniatrogenic 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.”
Collapse
Click Here to Manage Email Alerts