Castanon A, Landy R, Brocklehurst P, Evans H, Singh N, Walker P, Peebles D, Patnick J, Sasieni P for the PaCT Study Group
Wolfson Institute of Preventive Medicine
Sadler, JAMA 2004
Women attending colp 426 Not treated 652 Treated
RR 1.1 (0.8-1.5) overall RR 3.6 (1.8-7.5) depth ≥17mm
Kyrgiou, Lancet 2006
8 studies 3 studies
RR 1.70 (1.24-2.35) overall RR 2.61 (1.285-5.34 ) depth >10mm
Albrechtsen, BMJ 2008
15,108 births post-colp, 17.2% preterm 57,136 births pre-colp, 6.7% preterm
RR 4.4 (3.8-5.0) 24-27 weeks RR 2.5 (2.4-2.6) 33-36 weeks
Bruinsma, BJOG 2011
6 Studies
7 studies
RR 1.25 (0.98-1.58), Punch vs. treated RR 1.96 (1.46-2.64), Post vs. pre treatment
Studies using UK data suggested a weaker association.
In England colposcopy and treatment of CIN is quality assured
St Mary's
Royal Cornwall
Whipps Cross
The James Cook
St James's University Hospital Royal Preston Hospital
Wirral University Hospital Royal Hallamshire Hospital
Hammersmith
Royal Devon and Exeter
Barts & London
North Durham County and Darlington
Worcestershire Acute
Participating Hospitals
Colposcopy data: 1987-2009
NHS number
Date of birth
Hospital Episode Statistics
Obstetric data: 1998-2009
Wolfson Institute
Obstetric and
Colposcopy data
To explore the association between treatment at colposcopy and preterm delivery
Outcomes:
Preterm rates in England compared to those in women attending colposcopy
*Castanon et al (BMJ 2012)
The average preterm delivery rate in England between 2000-2012 was 6.7% (95% CI 6.6-6.8)
Out of 18,450 singleton births in our cohort 8.8% (95% CI 8.3-9.2) were preterm
The difference between these proportions is 2.1% (95% CI 1.7%-2.5%; p<0.0001)
Women attending colposcopy were 31% more likely to have a preterm birth than the general population (RR 1.31, 95% CI 1.25-1.37)
*Castanon et al (BMJ 2012)
Overall for the study
St Mary's Hospital, Imperial College
Royal Cornwall Hospital
Whipps Cross University Hospital
The James Cook University Hospital
Study Centre
St James's University Hospital
Royal Preston Hospital
Wirral University Teaching Hospital
Royal Hallamshire Hospital
Hammersmith Hospital, Imperial College
Royal Devon and Exeter NHS Foundation Trust
Barts and the London NHS Trust
North Durham County and Darlington Trust
8.8 (8.4, 9.2)
Proportion preterm (95% CI)
16.7 (11.8, 21.6)
8.8 (7.5, 10.1)
8.7 (7.6, 9.9)
10.4 (8.8, 12.0)
10.2 (8.5, 11.9)
7.8 (6.5, 9.2)
6.0 (5.2, 6.9)
10.1 (8.8, 11.5)
7.7 (6.3, 9.2)
8.9 (7.4, 10.3)
10.7 (9.3, 12.0)
6.2 (3.8, 8.6)
England 6.7 (6.62, 6.76)
Preterm births were more common among women attending colposcopy before birth (8.9%) than after birth (7.5%)
*Castanon et al (BMJ 2012)
Women treated at colposcopy were at increased risk compared to those with a punch only. This was true both for births after colposcopy and for births before colposcopy!
Birth after colposcopy
Adjusted RR Cone:Punch
1.19 (1.01-1.41) 1.31 (0.97-1.76)
*Castanon et al (BMJ 2012)
Women treated at colposcopy were at increased risk compared to those with a punch only. This was true both for births after colposcopy and for births before colposcopy!
Birth after colposcopy Birth before colposcopy
Adjusted RR After:Before colposcopy
Adjusted RR Cone:Punch
1.19 (1.01-1.41) 1.31 (0.97-1.76) 0.91 (0.66-1.26)
*Castanon et al (BMJ 2012)
Similarly, women giving birth post colposcopy were at increased risk compared to those giving birth before colposcopy. This was true even if they only had a punch biopsy at colposcopy!
LLETZ
Adjusted RR Post:Pre-colposcopy
1.33 (1.04-1.70) 1.45 (1.15-1.83)
*Castanon et al (BMJ 2012)
Similarly, women giving birth post colposcopy were at increased risk compared to those giving birth before colposcopy. This was true even if they only had a punch biopsy at colposcopy!
LLETZ Punch biopsy Adjusted RR After:Before colposcopy
Adjusted RR Post:Pre-colposcopy
1.33 (1.04-1.70) 1.45 (1.15-1.83) 0.91 (0.66-1.26)
*Castanon et al (BMJ 2012)
• The risk of preterm birth in England is substantially (and significantly) less than that found in most other studies predominantly from Nordic countries
• All aspects of colposcopy are quality managed in the UK
The increased risk in those attending colposcopy may be due to confounding and not caused by treatment
Co-authors Landy R and Castanon A– Centre for Cancer Prevention QMUL Brocklehurst P and Peebles D - Institute for Women's Health UCL Walker P, Evans H - Department of Gynaecology, Royal Free Hampstead NHS Trust Singh N - Division of Cellular Pathology, Barts and the London NHS Trust Patnick J - NHS Cancer Screening Programmes The PaCT Study Group Singh N and Parberry A (Barts Health NHS Trust); Ghaem-Maghami S and Soutter P (Royal Hammersmith Hospital); Lyons D (St Mary’s Hospital, Imperial College); Lincoln K and Rolland P (The James Cook University Hospital); Wood N and Preston S (Royal Preston Hospital); Senguita P and Dent J (North Durham County and Darlington Trust); Das N and Russ L (Royal Cornwall Hospital); Hannemann M and Fuller D (Royal Devon and Exeter NHS Foundation Trust); Palmer J(Royal Hallamshire Hospital); Hutson R (St James University Hospital); Hollingworth A and Wuntakal (Whipps Cross University Hospital); Gul N and Miles A (Wirral University Teaching Hospital); China S and Raghavan R (Worcestershire Acute Hospital NHS Trust)
These slides present independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient
Benefit (RfPB) Programme (Grant Reference Number PB-PG-1208-16187). The views expressed are those of the author(s) and not
necessarily those of the NHS, the NIHR or the Department of Health.
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