Management of low-grade cervical dysplasia (CIN 1): A Swedish perspective

Abstract

In Sweden, women are invited between the age 23–50 every third year and between the age of 50–60 every fifth year. We decided to utilise this existing organisation for evaluation of HPV triage in a real-life situation. Entire program is real-life evaluated, with no exclusion criteria, no research grants or sponsor funds, all costs paid by the health care system. All 15 hospitals and outpatient clinics in the greater Stockholm county were randomised to either: (1) Continue with the established policy (colposcopy of all women with ASC-US/LSIL), or (2) New policy with HPV triaging by HCII (high risk probes) and colposcopy of HPV-positive women only. Hospitals/outpatient clinics were randomised pair-wise with matching of the catchment area population size and CIN 2+ incidence in that population. Until today, we have found 63% ASC-US cases and 75% LSIL as HR-HPV positive. HPV positivity is strictly age-dependent. No significant difference in the number CIN 2+ was found in the two different arms. The costs are almost the same in the two groups, with potential modest savings by the new policy. The costs of follow-up and management of the women with low grade cervical lesions are considerable. It is anticipated that vaccination against high-risk and low-risk HPV types will significantly reduce the occurrence of these lesions in the population.