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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Risk of Injuries around Diagnosis of Cervical Cancer and Its Precursor Lesions: A Nationwide Cohort Study in Sweden

Qing Shen, Donghao Lu, Bengt Andrae, Maria E.C. Schelin, Arvid Sjölander, Yang Cao, Pär Sparén and Fang Fang
Qing Shen
1Institutet of Environmental Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
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  • For correspondence: qing.shen@ki.se
Donghao Lu
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
3Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Bengt Andrae
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
4Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden.
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Maria E.C. Schelin
5Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.
6Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
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Arvid Sjölander
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
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Yang Cao
7Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
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Pär Sparén
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
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Fang Fang
1Institutet of Environmental Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
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DOI: 10.1158/1055-9965.EPI-20-0673 Published November 2020
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Abstract

Background: Highly increased risk of injuries has been noted around the time of cancer diagnosis. Whether there is a similar increase in risk around the diagnosis of cervical cancer and its precursor lesions was unknown.

Methods: We performed a cohort study including 3,016,307 Swedish women that participated in cervical screening during 2001 to 2012. We calculated the incidence rates (IR) of hospitalized iatrogenic or noniatrogenic injuries during the diagnostic workup, and the time interval from smear or punch biopsy until surgical treatment or 2 months after the last smear or biopsy, among women with invasive cervical cancer (ICC) or its precursor lesions. We calculated the IRs of injuries during the 2 months after a normal smear among the other women as reference. IR ratios (IRR) and 95% confidence intervals (CI) were calculated using Poisson regression.

Results: Compared with other women, there was an increased rate of iatrogenic injuries during the diagnostic workup of women with ICC (IR, 0.58 per 1,000 person-months; IRR, 8.55; 95% CI, 3.69–19.80) as well as of women with cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ (IR, 0.09 per 1,000 person-months; IRR, 3.04; 95% CI, 1.73–5.34). We also found 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, 1.30–4.47).

Conclusions: Although rare, there was an increased risk of inpatient care for iatrogenic and noniatrogenic injuries during the diagnostic workup of women with ICC.

Impact: Women experienced burden of medical complications and psychologic distress around diagnosis of a potential cervical cancer.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;29:2230–4

  • Received May 5, 2020.
  • Revision received June 25, 2020.
  • Accepted August 14, 2020.
  • Published first October 21, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (11)
November 2020
Volume 29, Issue 11
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Risk of Injuries around Diagnosis of Cervical Cancer and Its Precursor Lesions: A Nationwide Cohort Study in Sweden
Qing Shen, Donghao Lu, Bengt Andrae, Maria E.C. Schelin, Arvid Sjölander, Yang Cao, Pär Sparén and Fang Fang
Cancer Epidemiol Biomarkers Prev November 1 2020 (29) (11) 2230-2234; DOI: 10.1158/1055-9965.EPI-20-0673

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Risk of Injuries around Diagnosis of Cervical Cancer and Its Precursor Lesions: A Nationwide Cohort Study in Sweden
Qing Shen, Donghao Lu, Bengt Andrae, Maria E.C. Schelin, Arvid Sjölander, Yang Cao, Pär Sparén and Fang Fang
Cancer Epidemiol Biomarkers Prev November 1 2020 (29) (11) 2230-2234; DOI: 10.1158/1055-9965.EPI-20-0673
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