Evidence map›Paper›PMID 31959338›Full record

SynthesisAnnals of oncology : official journal of the European Society for Medical Oncology2020

Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature.

I Kalliala, A Athanasiou, A A Veroniki, G Salanti, O Efthimiou, N Raftis, S Bowden, M Paraskevaidi, K Aro, M Arbyn and 4 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of oncology : official journal of the European Society for Medical Oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 8 pooled it
13.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 8 syntheses or guidelines pooled it, 160 citations in OpenAlex.

  1. Prophylactic HPV vaccination in HPV-related gynecologic cancers: European Society of Gynecological Oncology (ESGO) prevention committee opinion.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
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  10. Efficacy of a Smoking Cessation Intervention for Survivors of Cervical Intraepithelial Neoplasia or Cervical Cancer: A Randomized Controlled Trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023
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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 5 countries.

I KallialaInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
A AthanasiouInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
A A VeronikiInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
G SalantiInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
O EfthimiouInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
N RaftisDepartment of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece.
S BowdenInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
M ParaskevaidiInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.
K AroDepartment of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
M ArbynUnit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
P BennettInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
P NieminenDepartment of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
E ParaskevaidisDepartment of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece.
M KyrgiouInstitute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: m.kyrgiou@imperial.ac.uk.
Imperial College London · GBHelsinki University Hospital · FIInstitute of Social and Preventive Medicine · CHUniversity Hospital of Ioannina · GRInstitut Scientifique de Santé Publique · BEUniversity of Helsinki · FI

Funding

Department of Health PB-PG-0816-20004Wellcome Trust
6 · The paper itself

Abstract

backgroundAlthough local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population. MATERIALS AND

methodsDesign: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. DATA SYNTHESIS: Summary effects were estimated using random-effects models. OUTCOMES: Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population.

resultsTwenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22-69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57-4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58-21.10; P < 0.001), vulvar (3.34, 2.39-4.67; P < 0.001), and anal cancer (5.11, 2.73-9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69-36.94; P = 0.073).

conclusionsWomen treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.

Indexed as

AlphapapillomavirusPapillomavirus InfectionsUterine Cervical DysplasiaUterine Cervical NeoplasmsFemaleHumansIncidenceMiddle Agedcancer incidencecancer mortalityCINconisationHPV-related cancerLLETZ

Identifiers

PMID31959338
PMCPMC7479506
OpenAlexW2999393293

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.