Atypical Glandular Cells At Screening Flag Cervical Cancer Risk

Atypical glandular cells at cervical screening indicate an increased risk of invasive cervical cancer

medwireNews: Women who have atypical glandular cells (AGC) at cervical screening have a high and persistent risk of developing cervical cancer for up to 15 years, say Swedish researchers.

“Women with AGC found at screening should be properly assessed with histology immediately and must not be lost to follow-up”, recommend Jiangrong Wang, from the Karolinska Institutet in Stockholm, and co-authors in The BMJ.

“According to our findings, we cannot assume such women are at low risk after only one assessment”, they emphasize.

The team collated information from 3,024,340 women living in Sweden, aged 23 to 59 years, who underwent cervical cytological examination between 1980 and 2011. The first abnormal result reported was AGC for 14,625 patients, high-grade squamous intraepithelial lesion (HSIL) for 65,633 patients and low-grade (L)SIL for 244,168 patients.

Over 15.5 years of follow-up, the cumulative incidence of cervical cancer was 2.6% for women with AGC compared with 0.7% for LSIL patients and 3.3% for those with HSIL.

The corresponding cumulative incidence of adenocarcinoma was 1.9% for patients with AGC, and this was significantly higher than for LSIL and HSIL patients, whereas the cumulative incidence of squamous cell carcinoma was 0.6% and comparable to that found in HSIL patients.

Compared with women with normal cytology at the index screening, the incidence rate ratio (IRR) for invasive cervical cancer after AGC was 24.1 for 0.5–3.5 years after detection, falling to 4.8 after 10.5 to 15.5 years. The IRR after AGC was higher than the IRRs for LSIL and HSIL patients versus normal cytology patients for the first 6.5 years.

Indeed, the IRR of adenocarcinoma in women for the first screening after AGC diagnosis was 60.8 times higher than for the women with normal cytology and remained 9.4 times higher between 10.5 and 15.5 years after diagnosis.

Jiangrong Wang et al highlight that the incidence and prevalence of invasive cervical cancer was greatest for women who were aged 30 to 39 years at the time of AGC diagnosis.

Noting that just 54% of women with AGC underwent a histology assessment within 6 months of diagnosis, compared with 86% of HSIL patients, the authors suggest that management of such patients may be “suboptimal”.

“A more aggressive assessment strategy seems to be warranted, for example by including an additional histology assessment in one year and close surveillance for many years”, they comment.

“Particular attention should be given to women aged 30-39.”

But the researchers add: “The rarity of AGC makes the long term close surveillance feasible, in terms of administration and cost.”

Reference

Wang J, Andrae B, Sundström K, et al. Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study. BMJ 2016; 352: i276 11 February. doi: http://dx.doi.org/10.1136/bmj.i276

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