Cervical cancer survivors prone to other cancers

Women who survive cervical cancer are at increased risk for developing other cancers decades later, according to a report in the Journal of the National Cancer Institute. The increased cancer risk is primarily seen in women who were treated with radiation therapy and involves organs that lie near the cervix.
"Previous studies have indicated that the risk of second cancers is increased among cervical cancer survivors, but overall and (body) site-specific risks among very long-term survivors were unclear," Dr. Anil K. Chaturvedi, from the National Cancer Institute in Bethesda, Maryland, and colleagues note.
The findings are based on an analysis of data for 104,760 cervical cancer survivors drawn from several Scandinavian countries and the U.S. The researchers calculated the rate of second cancers over more than 40 years of follow-up.
On the overall analysis, the survivor group was 30 percent more likely to develop a cancer than were women in the general population. Further analysis showed that the rates of human papillomavirus (HPV)- and smoking-related cancers were elevated in survivors who had radiotherapy and those who did not.
Survivors treated with radiotherapy had an elevated risk for cancers in close proximity to the cervix, including cancers of the colon, rectum, anus, bladder, ovaries and genitals. By contrast, no increased risk for these cancers was seen in survivors who did not receive radiotherapy.
The 40-year cumulative rate of a second cancer was higher for survivors diagnosed with cervical cancer before rather than after they were 50 years old: 22.2 vs. 16.4 percent, respectively.
"The most important finding is that even 40 years after a diagnosis of cervical cancer, survivors remain at increased risk of second cancers. These results are consistent with previous studies that showed increased second cancer risks beyond 30 years of follow-up, but that did not have sufficient data on time periods beyond 30 years," Chaturvedi told Reuters Health.
"The increased second cancer risk among cervical cancer survivors underscores the need for screening or regular medical surveillance," he emphasized.

Some face long-term cervical cancer risk

Women with pre-cancerous lesions may need follow-up tests for 25 years
Women treated for pre-cancerous lesions are at increased risk of developing cervical or vaginal cancer for at least another 25 years, according to a study suggesting that follow-up tests fall dangerously short.
Using data from Sweden’s national cancer registry, the researchers said on Friday women who have had severe lesions in the cervix are more than twice as likely to develop one of the two cancers than women in the general population.
The findings underscore the need for follow-up tests to continue for at least 25 years after treatment, far longer than the current five or 10 years standard in most European countries, said Bjorn Strander, a gynecologist at Sahlgren’s University Hospital in Sweden, who led the study.

“This is a warning to the healthcare system to keep track of these women,” he said in a telephone interview. “It has not been known these women remain at risk for such a very long time.”
Most cases of cervical cancer are caused by the sexually transmitted human papilloma virus and is the second most common type of cancer in women. Vaginal cancer is far more rare, with about 13,000 women diagnosed each year.

Risk remains steady
Women in many countries have an annual Pap smear to check for early signs of these lesions, which are easily removed if caught before they develop into cancer.
Nonetheless cervical cancer kills 300,000 each year, mostly in developing countries. Merck and Co’s Gardasil and GlaxoSmithKline’s Cervarix vaccines protect people against certain strains of HPV, but not all.

In their study, the researchers mined the National Swedish Cancer Register for information recorded from 1958 to 2002 on more than 132,000 women diagnosed with pre-cancerous lesions.
They found that 881 women had developed cervical cancer and 111 women had vaginal cancer more than one year following their diagnosis — even after they had their lesions removed.
And the risk remained high for a long time, they said.
“We haven’t investigated why but there are indications it could be because a lack of surveillance,” Strander said. "The risk is quite steady. It does not decrease.”
A woman’s risk also rose if she was older at diagnosis, also possibly due to the healthcare system letting down its guard during follow-up care, Strander said.
The Swedish study, published in the British Medical Journal, did not look at whether a Pap smear or DNA test represented the best way to screen these women but said it merits further study, Strander added.
Two Italian researchers writing in a related editorial agreed the findings should spark further study and said they clearly show current testing guidelines are not sufficient.
“One clear indication is that women treated for (severe pre-cancerous lesions) should continue surveillance beyond the age limit of regular screening,” they wrote.

HPV test detects cancer with 95% accuracy

No one wants cervical cancer screening to be like flipping a coin.
A recent study revealed the human papillomavirus (HPV) test is more effective at detecting cervical cancer than traditional Pap smears.
The preliminary research of the Canadian Cervical Cancer Screening Trial (CCCaST) was led by Dr. Eduardo Franco, director of the Division of Cancer Epidemiology at McGill University’s Faculty of Medicine.
Dr. Franco’s study discovered the HPV test detects signs of cancer with an accuracy rate of 94.6 per cent without generating false results. The Pap test has an accuracy rate of 55.4 per cent, which Franco compared to “flipping a coin.”
The CCCaST’s results, published in The New England Journal of Medicine, offer an alternative to the Pap smear, which has been the standard test for cervical cancer for almost 50 years.
Both the Pap smear and HPV test require the collection of a cervical sample; the difference lies in the analysis of the sample, explained Dr. Peter Ainsworth, head of molecular diagnostics at the London Health Science Centre.
Pap tests analyze cells under a microscope searching for abnormalities, while the HPV test is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
“The Pap smear is looking at dismorphisms [where] the cells take different shapes and don’t look normal,” Ainsworth said.
“This DNA test is actually looking for the viral genome of these two specific subtypes of [HPV] that cause [cervical] cancer. They have a specific DNA sequence.”
The study concluded although the sensitivity of the HPV test was almost 40 per cent higher than the Pap test, the latter is less likely to generate false positives.
In a press release, Dr. Franco noted while a false positive may be psychologically distressing for a patient, it is more desirable than a false negative — which could allow cancer to develop undetected.
Ainsworth said, the HPV test will likely be an add-on to traditional screening.
“You must be very cautious about adopting a test without being fully sure that it is doing the job the original test is doing,” Ainsworth said.
Dr. P.K. Lala, professor emeritus of anatomy and cell biology at Western, said the HPV test is powerful.
“But on the other hand, it’ll take time for the test to be readily available.”