Risk of HPV-related extra-cervical cancers in women treated for cervical intraepithelial neoplasia.

BACKGROUND: The aim was to estimate the risk of subsequent extra-cervical Human Papillomavirus (HPV) related cancer in patients surgically treated for high grade cervical intraepithelial neoplasia (CIN 2-3). This is the first study in Italy investigating the occurrence of extra-cervical tumors in this cohort of patients. METHODS: 3184 patients surgically treated for CIN2-3 since 1992 at the Department of Surgical Sciences of University of Torino were considered. The risk of HPV-related cancer was calculated as Standardized Incidence Ratio (SIR), using as expected values tumour age specific incidence of resident population. RESULTS: 173 second primary cancer (SCPs) were identified. SIR to develop cancer after treatment for CIN2-3 was 2.2 (CI 95% 1.89-2.50). Among these occurrences, 10 are in HPV related sites: 1 anus (SIR = 1.8; 0.04-10.0), 3 vagina (SIR = 12.4; 2.56-36.3), 1 vulva (SIR = 1.7; 0.04-9.59), 5 oropharynx (SIR = 8.5; 2.76-19.8). Significant risk has been also recorded for pulmonary (SIR = 3.1; 0.70-5.27) and bladder (SIR = 4.05; 1.10-10.56), with smoking as possible cofactor. We also found increased risk for breast (SIR = 2.4; 2.07-2.84) and ovarian cancers (SIR = 2.1; 1.13-3.49), probably due to an higher adherence to spontaneous and programmed screening programs. CONCLUSIONS: Our study supports the hypothesis of an increased risk of HPV-related tumours for CIN treated patients, mostly for CIN3. It is conceivable the need of early diagnosis for these cancers in this higher-risk populations.

[What are we learning from the new data on cancer incidence in North Africa]. / Cosa dicono i nuovi dati sull'incidenza del cancro in Africa settentrionale.

Over a period of a few years, Cancer registries in North Africa (Morocco, Algeria, Tunisia, Libya, Egypt) increased in number from one to seven. Currently they serve 9.7% of the total regional population. The pattern of risk presented by their data (which appear to be good enough, according to the available indicators) is unique. The total cancer burden in different North Africa countries is between one fourth and one half (on average one third) of the corresponding risk in Europe. The overall rate, age standardized on world population, ranges in men from 94.0/100,000 in Sètif, Algeria, to 162.9/100,000 in Garbiah, Egypt. Similar is the range of the risk between countries in women (from 84.7 and 164.0/100,000). The case mixing and the level of the site specific rates are quite homogeneous between the considered countries. The most frequent cancers are those observed in Europe (lung, breast, colon, prostate). This pattern completely differs from that of black Africa countries, where infection-related cancers predominate. The clinically well known excess risk for nasopharyngeal carcinoma in Maghrebi countries is confirmed and quantified by the presented data (with rates as high as 5.4/100,000 in men and 1.9/100,000 in women, ten times higher than in Europe).