Women Face Burden of Medical Complications, Psychologic Distress Around Cervical Cancer Diagnosis

“This study for the first time systematically examined the risks of injuries during the cervical diagnostic workup,” said corresponding author Qing Shen, PhD.

A study published in Cancer Epidemiology, Biomarkers & Prevention revealed that women experienced burden of medical complications and psychologic distress around the time of a potential cervical cancer diagnosis.1

“Cervical cancer screening is one of the most successful cancer prevention programs which has greatly reduced cervical cancer incidence and mortality,” corresponding author Qing Shen, PhD, researcher in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, said in a press release.2 “Despite these substantial benefits, our research indicates that women with invasive cervical cancer experienced medical complications and psychological stress during their diagnostic workup.”

In this cohort study, researchers evaluated 3,016,307 Swedish women that participated in cervical screening from 2001 to 2012. Using this data, researchers calculated the incidence rates (IR) of hospitalized iatrogenic or noniatrogenic injuries experienced throughout a given patients’ diagnostic workup, as well as the time interval from smear or punch biopsy until surgical treatment or 2 months after the last smear or biopsy, among women with invasive cervical cancer (ICC) or its precursor lesions. In addition, the IRs of injuries during the 2 months following a normal smear among the other women were also calculated as a reference.

When compared with other women, researchers found there was an increased rate of iatrogenic injuries during the diagnostic workup of women with ICC (IR, 0.58 per 1,000 person-months; IRR, 8.55; 95% CI, 3.69-19.80) as well as of women with cervical intraepithelial neoplasia of grade 3 and adenocarcinoma in situ. Moreover, an increased rate of noniatrogenic injuries during the diagnostic workup of women with invasive cancer was also observed (IR, 0.65 per 1,000 person-months; IRR, 2.48; 95% CI, 1.30-4.47).

“An increase in non-iatrogenic injuries points to high levels of psychological distress in relation to receiving a diagnosis of cervical cancer,” Shen explained in the release. “Women with cervical cancer can be criticized about their sexual behaviors, leading to a social stigma that could contribute to this stress.”

“This study for the first time systematically examined the risks of injuries during the cervical diagnostic workup,” added Shen. “Although the chance of having such injuries was rare, we found an increased risk of inpatient care for iatrogenic and non-iatrogenic injuries for women with invasive cervical cancer. It is important to emphasize, however, that cervical cancer screening is greatly beneficial for the early detection of cancer and is largely safe.”

Importantly though, this study lacked information regarding nonsurgical treatments, including palliative care, chemotherapy, and radiotherapy, for women with ICC. Information on cancer stage was also not available during the entire study period.

Additionally, these study results may not be generalizable to other populations, as screening protocols may vary by population.


1. Shen Q, Lu D, Andrae B, et al. Risk of Injuries Around Diagnosis of Cervical Cancer and Its Precursor Lesions: A Nationwide Cohort Study in Sweden. Cancer Epidemiology, Biomarkers & Prevention. doi: 10.1158/1055-9965.EPI-20-0673

2. Women With Cervical Cancer May Have Increased Risk of Injury During Diagnostic Workup [news release]. Philadelphia. Published October 21, 2020. Accessed October 21, 2020.