Abstract
Cervical intraepithelial neoplasia grade 2 (CIN2) frequently regresses, is typically slow-growing, and rarely progresses to cancer. Some women forgo immediate treatment, opting for conservative management (heightened surveillance with cytology and colposcopy), to minimize overtreatment and increased risk of obstetric complications; however, there are limited data examining clinical outcomes in these women. We performed a retrospective cohort analysis of younger women diagnosed with initially untreated CIN1/2, CIN2 and CIN2/3 lesions at Kaiser Permanente Northern California between 2003 and 2015. Clinical outcomes were categorized into five mutually exclusive hierarchical groups: cancer, treated, returned to routine screening, persistent high-grade lesion, or persistent low-grade lesion. Median follow-up for the 2,417 women was 48 months. Six women were diagnosed with cancer (0.2%), all with history of high-grade cytology, and none after a negative cotest. Thirty percent of women were treated, and only 20% returned to routine screening; 50% remained in continued intensive follow-up, of which 86% had either low-grade cytology/histology or high-risk human papillomavirus (HPV) positivity, but not necessarily persistence of a single HPV type. No cancers were detected after a single negative cotest in follow-up. Almost half of initially untreated women did not undergo treatment, but remained by protocol in colposcopy clinic for 2 or more years in the absence of persisting CIN2+ Their incomplete return to total negativity was possibly due to sequential new and unrelated low-grade abnormalities. The prolonged colposcopic surveillance currently required to return to routine screening in the absence of persisting CIN2+ might not be necessary after a negative cotest.Significance: Many younger women under conservative management following an initial CIN2 result remain in a clinical protocol of prolonged intensified surveillance without a subsequent diagnosis of CIN2 or more severe diagnoses. More research is needed to determine whether such prolonged management might be unnecessary following a negative cotest for those women with an initial CIN2 but otherwise only low-grade findings. Cancer Prev Res; 11(3); 165-70. ©2018 AACR.
Highlights
Cervical cancer incidence rates have declined dramatically where screening programs have been successfullyNote: Supplementary data for this article are available at Cancer Prevention Research Online.Ó2018 American Association for Cancer Research.implemented, as precancerous high-grade cervical lesions are detected before the onset of cervical cancer and treated [1,2,3]
The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines specify that observation is preferred for young women with a diagnosis of CIN grade 2 (CIN2), acceptable for young women with CIN2/3, and not www.aacrjournals.org recommended for young women with unambiguous cervical intraepithelial neoplasia grade 3 (CIN3) [3, 10]
We further restricted our analysis to lesions that would be considered eligible for conservative management (CIN1/2, CIN2, and CIN2/3), excluding 6,015 women with CIN3þ
Summary
Cervical cancer incidence rates have declined dramatically where screening programs have been successfullyNote: Supplementary data for this article are available at Cancer Prevention Research Online (http://cancerprevres.aacrjournals.org/).Ó2018 American Association for Cancer Research.implemented, as precancerous high-grade cervical lesions are detected before the onset of cervical cancer and treated [1,2,3]. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines specify that observation is preferred for young women with a diagnosis of CIN2, acceptable for young women with CIN2/3, and not www.aacrjournals.org recommended for young women with unambiguous CIN3 [3, 10]. Such conservative management (intensified surveillance with cytology and colposcopy instead of immediate treatment) is sometimes preferred among women still desiring childbearing because of the increased risk of future obstetric complications associated with excisional treatment [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
