Excess bodyweight may hinder cervical precancer diagnosis and increase cancer risk
medwireNews: Increasing bodyweight is associated with an elevated risk for developing invasive cervical cancer, most likely due to the under-detection of cervical precancer, say US researchers.
Given the worldwide obesity epidemic and the fact that screening remains the mainstay of cervical cancer prevention, they believe that these results “have significant implications for the secondary prevention of cervical cancer and signify the need for greater awareness and possibly the development of specific clinical recommendations for screening overweight and obese women.”
The analysis included 944,227 women aged 30–64 years who underwent screening by cytology and human papillomavirus (HPV) DNA co-testing at Kaiser Permanente Northern California in Oakland, USA, between 2003 and 2015. Among these, 31.3% were classed as obese (body mass index [BMI] ≥30 kg/m2), 30.2% as overweight (25 to <30 kg/m2), and 38.6% as normal or underweight (<25 kg/m2).
The 5-year cumulative risk for cervical precancer – defined as cervical intraepithelial neoplasia of grade 3 and adenocarcinoma in situ – was lowest for obese women, at 0.51%, rising to 0.61% for overweight women and 0.73% for normal or underweight women, such that the differences between groups was significant.
By contrast, obese women had a significantly greater risk for invasive disease, with a 5-year cumulative risk of 0.083%, compared with 0.071% for the overweight group and 0.056% for the normal or underweight group.
The findings were consistent when participants were categorized by age (30–49 vs 50–64 years), HPV status (positive vs negative), and histology (glandular vs squamous).
Megan Clarke (National Cancer Institute, Bethesda, Maryland) and co-researchers note that “the apparent paradoxical association of excess BMI with decreased risk of precancer, but increased risk of cancer, is likely related to underdiagnosis of cervical precancer in overweight and obese patients who were screened for cervical cancer.”
And they write in the Journal of Clinical Oncology that “[g]oing forward, it will be important to validate which components of the cervical cancer screening process are failing.”
The study authors continue: “Whether existing equipment (eg, speculum size) and procedures are adequate for visualization and sampling of the cervix in overweight and obese women requires further evaluation.”
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