Abstract
We analyzed the management and risk of subsequent cervical intraepithelial neoplasm 3 (CIN3) and invasive cervical cancer in women with low-grade squamous intraepithelial lesion (LSIL) cytology. A total of 53,293 women with a new diagnosis of cytologic LSIL were identified in Taiwan’s national cervical screening registration database. Based on the retrieved clinical management data, the incidence of subsequent CIN3+ lesions was determined, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. The average follow-up was 5.02 years. A total of 988 women developed CIN3+ lesions during this period, with an overall incidence of 369.3 women per 100,000 person-years. Cryotherapy and conization/loop electrosurgical excision procedure (LEEP) decreased the subsequent risk of CIN3+ lesions in women younger than 50 years (HR 0.49, 95% confidence interval [CI] 0.37–0.64, p<0.0001 for cryotherapy; HR 0.39, 95% CI 0.27–0.55, p<0.0001 for LEEP). Cryotherapy and conization/LEEP were two significant protective factors for developing CIN3+ lesions, especially in women with biopsy-proven CIN1 (HR 0.55, 95% CI 0.37–0.82, p = 0.003 for cryotherapy; HR 0.43, 95% CI 0.24–0.77, p = 0.005 for LEEP). These results suggest that when women are first screened LSIL and lack prior abnormal cervical cytology, cryotherapy should be one of the treatment options. Younger women with a histological biopsy diagnosis of CIN1 were most likely to benefit from cryotherapy.
Highlights
Cervical cancer is the third most common cancer in women, with an estimated 528,000 new cases and 266,000 deaths worldwide per year. [1] According to the 2013 annual cancer registry report in Taiwan, the incidence of cervical cancer is the seventh most common cancer in women, and a total of 1,579 women were diagnosed in 2013, giving an age-adjusted incidence of 9.46 per 100,000 person-years
Women were excluded if the interval between the low-grade squamous intraepithelial lesion (LSIL) cytology finding and the histologic diagnosis of cervical intraepithelial neoplasm 3 (CIN3)+ lesions was less than one year in order to avoid the inclusion of occult CIN3+ lesions from the initial screenings
Our results indicated that cryotherapy and conization/loop electrosurgical excision procedure (LEEP) are two strong protectors against subsequent CIN3+ lesions in women with both LSIL cytology and cervical intraepithelial neoplasia 1 (CIN1) pathology
Summary
Cervical cancer is the third most common cancer in women, with an estimated 528,000 new cases and 266,000 deaths worldwide per year. [1] According to the 2013 annual cancer registry report in Taiwan, the incidence of cervical cancer is the seventh most common cancer in women, and a total of 1,579 women were diagnosed in 2013, giving an age-adjusted incidence of 9.46 per 100,000 person-years. A cervical cancer screening program was launched in Taiwan in 1995 that included annual Pap test reimbursement; this decreased the incidence of invasive cancer by 47.8% in 1995–2006. [2] In Taiwan, cervical screening using either Pap smear or liquid based cytology starts three years after a woman becomes sexually active or when she is 30 years old, and there is no upper age limit for screening. Women aged 20–29 years who are not covered by the national screening program can still participate in screening if they have risk factors such as early commencement of sexual activity, a high number of partners, or a history of abnormal bleeding. HPV testing is not recommended in women aged < 30 years
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