Risk of gynaecological cancer after atypical glandular cells found on cervical cytology: a population-based cohort study
Menée aux Pays-Bas à partir de données 2000-2015 portant sur 8 537 385 frottis cytologiques et sur 9 061 patientes atteintes d'un cancer, cette étude analyse l'association entre la détection d'atypies des cellules glandulaires et le risque de cancer gynécologique
Background: Atypical glandular cells (AGC) are rare abnormalities found on cervical cytology associated with a range of lesions of the female reproductive system. We compared the risk of cervical and other gynaecological cancers following AGC on cervical cytology with the risk following squamous cell abnormalities of comparable severity.
Methods: We used data from the Dutch Pathology Archive (PALGA) from 2000-2015 to categorise cervical cytology tests into groups based on most severe cytological abnormality and correlated follow-up advice (normal cytology and 'no follow-up' advice, squamous-cell based-, AGC-based, and combined AGC/squamous-cell based each with either repeat testing or referral advice). Cancer data were linked from the Netherlands Cancer Registry. Cox proportional hazard models were calculated stratified by age (younger (<50 years) and older (50+ years)), adjusted for number of previous primary cytology tests.
Results: 8,537,385 cytology smears and 9,061 cancers were included. When repeat cytology testing was advised, hazard ratios (HR) of cervical cancer (younger women - HR: 6.91, 95% CI: 5.48 - 8.71; older- HR: 3.98, 95% CI: 2.38 - 6.66) or other gynaecological cancer diagnosis in younger women (HR: 2.82, 95% CI: 1.39 - 5.74) were significantly higher after an AGC-based abnormality compared with squamous-based abnormalities. Hazards were also significantly higher for 'referral' advice cytology, except for cervical cancer amongst older women (HR: 0.88, 95% CI: 0.63 - 1.21).
Conclusions: AGC indicates an increased risk of gynaecological cancer compared to squamous-based abnormalities of comparable severity.
Impact: Gynaecologists should be alert for cervical and endometrial cancers when examining women referred following AGC.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2020