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Monitoring appropriate for some cervical lesions?

Wednesday February 28th, 2018

Most pre-invasive cervical cancer lesions regress spontaneously, particularly in women below the age of 30 years, researchers report today.

Cervical intraepithelial neoplasia grade 2 directed on cervical biopsy has been considered the clinical cut-off to proceed to treatment. However, Dr Maria Kyrgiou and colleagues at Imperial College London, UK, explain that the clinical course of this stage is not well understood.

Some studies have suggested that spontaneous regression rates may be high - so the team reviewed 36 previous studies including 3,160 women.

In the BMJ today (28 February), they report that 50% of untreated cervical intraepithelial neoplasia grade 2 lesions regress spontaneously, and 18% progress to cervical intraepithelial neoplasia grade 3 or worse within two years of surveillance. The rates are 60% and 11% in women aged less than 30.

Furthermore, "Among more than 3,000 women, there were only 13 stage 1A1 (0.4%) and two more advanced (0.06%) invasive cases, most in women older than 30."

Based on these figures, they estimate that in 1,000 women aged under 30 with a diagnosis of cervical intraepithelial neoplasia grade 2, 600 will experience regression, 230 will remain unchanged, and 110 will progress within two years of active surveillance.

They conclude: "Most cervical intraepithelial neoplasia grade 2 lesions, particularly in young women, regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring."

Tainio, K. et al. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 28 February 2018; doi: 10.1136/bmj.k499 [abstract]

Tags: Cancer | UK News | Women's Health & Gynaecology

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