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Original research
Cervical cancer and risk of dementia: real-world insights from a nationwide cohort study in Taiwan
  1. Siou-Ting Lee1,2,3,
  2. Yi-Liang Lee1,3,
  3. Chi-Hsiang Chung4,5,
  4. Wu-Chien Chien4,5,
  5. Sung-Tao Li3,6,
  6. Chia-Yi Yao3,6 and
  7. Nian-Sheng Tzeng6,7
    1. 1 Department of Obstetrics and Gynecology, Tri-Service General Hospital, Taipei, Taiwan
    2. 2 Department of Obstetrics and Gynecology, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan
    3. 3 School of Medicine, National Defense Medical Center, Taipei City, Taiwan
    4. 4 Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
    5. 5 School of Public Health and Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan
    6. 6 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
    7. 7 School of Medicine and Student Counseling Center, National Defense Medical Center, Taipei City, Taiwan
    1. Correspondence to Dr Nian-Sheng Tzeng, Department of Psychiatry, Tri-Service General Hospital, Taipei 19189, Taiwan; pierrens{at}mail.ndmctsgh.edu.tw; Professor Wu-Chien Chien; chienwu{at}mail.ndmctsgh.edu.tw

    Abstract

    Objective Cervical cancer, linked to human papillomavirus (HPV), ranks fourth among women’s cancers globally. Several studies have found an association between viral infections or cancer and dementia, which is a major public health concern. This study aimed to provide real-world data on the association between cervical cancer and the risk of dementia.

    Methods This population-based cohort study, utilizing Taiwan’s National Health Insurance Research Database, included 53 905 patients, with 10 781 having cervical cancer, matching with 43 124 controls in a 1:4 ratio based on age and indexed date. Incidence density rates were used to calculate the incidence rate of dementia. Adjusting for comorbidities, a multivariable Cox proportional hazards regression model was used to estimate the hazard ratios and 95% confidence intervals. Additionally, the risk of dementia was further verified using the cumulative incidence analyzed by the Kaplan–Meier method.

    Results This study indicated a significantly higher dementia risk in the cervical cancer cohort compared with the non-cervical cancer cohort (adjusted HR (aHR)=1.64, 95% CI 1.16 to 2.26; p<0.001), suggesting a 1.64-fold increased risk. Notably, cervical cancer posed a greater risk of dementia (aHR=1.69, 95% CI 1.21 to 2.29; p<0.001) compared with carcinoma in situ of the cervix (p=0.18) and cervical intraepithelial neoplasia (p=0.23). The cumulative incidence of dementia in the cervical cancer group was significantly higher (log-rank test, p<0.001) than the control group.

    Conclusions Cervical cancer (invasive disease) was associated with a significant risk of dementia, unlike carcinoma in situ of the cervix and cervical intraepithelial neoplasia (pre-invasive diseases), suggesting HPV infections may play a role in dementia, particularly oncogenic types. This highlights the importance of further investigation into the underlying mechanisms of the association between cervical cancer and dementia.

    • Cervical Cancer
    • Gynecology

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    https://doi.org/10.1136/ijgc-2024-005408

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

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      Footnotes

      • Contributors Study conception and design: S-TL, N-ST. Collection and assembly of data: S-TL, C-HC, W-CC, C-YY, Y-LL, N-ST. Data analysis and interpretation: S-TL, C-HC, W-CC, C-YY, Y-LL, N-ST. Manuscript writing, final approval of the manuscript, and accountable for all aspects of the work: all authors. Guarantors: N-ST, W-CC. The guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

      • Funding This study was funded and supported by the Medical Affairs Bureau, the Ministry of Defense of Taiwan (MND-MAB-110-087, MND-MAB-111-075, MND-MAB-112-085, MND-MAB-D-113059), the Tri-Service General Hospital Research Foundation (TSGH-B-109-010, TSGH-E-110240, TSGH-D-111121, TSGH-E-112259, and TSGH-B-113025), the Taoyuan Armed Forces General Hospital Research Foundation (TYAFGH-A-110020), and the Joint Grant from Cardinal Tien Hospital and National Defense Medical Center (CTH113A-NDMC-2224). These funding agencies did not influence the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.