La evolución a largo plazo de las lesiones precancerosas del cuello uterino y vagina

La mujer que ha sido tratada de lesiones precancerosas, displasia o carcinoma in situ (CIS) del cuello uterino o vagina, sigue teniendo riesgo de sufrir cáncer al cabo de 25 años.

Los científicos han revisado el Registro Sueco del Cáncer correspondiente a 132.493 mujeres controladas entre 1958 y 2002 por displasia o CIS. En ese grupo 881 desarrollaron cáncer de cuello y 111 cáncer de vagina en los 12 meses siguientes o más tarde. Una mujer con esos diagnósticos iniciales tiene el doble de riesgo para sufrir cáncer invasor en comparación con la población femenina general. El riesgo es mayor cuando la edad de la paciente es superior a los 50 años. Además, el riesgo en los primeros 10 años posteriores al diagnóstico inicial se realizo entre 1991 y 2000 que cuando se hizo entre 1958 y 1970. Estas diferencias pueden ser debidas a la forma de tratar a las pacientes.

BMJ. 2007 Oct 24; [Epub ahead of print]Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study.

Department of Obstetrics and Gynecology, Sahlgren's Academy, University of Gothenburg, SU/Östra sjukhuset, SE-416 85, Sweden.

OBJECTIVE: To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3. DESIGN: Prospective cohort study. SETTING: Swedish cancer registry. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: 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.

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