Aime Munro1,2,3, Rhys G Powell3,4, Paul A Cohen1,2,5, Shirley Bowen4, Katrina Spilsbury3, Peter O'Leary6, James B Semmens3, Jim Codde1, Vincent Williams7, Nerida Steel8, Yee Leung5. 1. Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia. 2. St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia. 3. Centre for Population Health Research, Curtin University, Bentley, WA, Australia. 4. School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia. 5. School of Women's and Infants' Health Research, University of Western Australia, Crawley, WA, Australia. 6. Faculty of Health Science, Curtin University, Bentley, WA, Australia. 7. School of Biomedical Sciences, Curtin University, Bentley, WA, Australia. 8. WA Cervical Cancer Prevention Program, Perth, WA.
Abstract
INTRODUCTION: CIN2 has a high rate of spontaneous regression in young women and may be managed conservatively in appropriately selected patients. This study aimed to investigate health outcomes in women aged 18-24 years with biopsy-confirmed CIN2. MATERIAL AND METHODS: A retrospective cohort study of Western Australian women aged 18-24 years diagnosed with CIN2 on cervical biopsy from 1 January 2001 to 31 December 2010. Women who had not received treatment at ≥4 months following CIN2 diagnosis were classified as managed 'conservatively'. Subsequent cervical cytology and/or biopsy test results were used to report lesion regression (absence of dysplasia or an epithelial lesion of lower grade than CIN2) and disease persistence (CIN2, CIN3 or ACIS). RESULTS: Follow-up data were available for 2417 women of whom 924 (38.2%) were 'conservatively' managed. In all, 152 (16.4%) conservatively managed women had a lesion more severe than CIN2 detected within 24 months of initial diagnosis, of which 144 were CIN3 and eight were ACIS. There was no statistically significant association between rates of regression and patient age, Socio-economic Indexes for Areas or Accessibility/Remoteness Index of Australia indices. The 2-year regression rate for CIN2 was estimated to be 59.5% (95%CI 0.5-0.6) in this cohort of women. CONCLUSION: In conservatively managed young women with CIN2 there was a high rate of spontaneous disease regression. Thus, excisional or ablative treatments may be avoided in selected patients who receive appropriate counseling and who are able to comply with more intensive and prolonged follow-up requirements.
INTRODUCTION: CIN2 has a high rate of spontaneous regression in young women and may be managed conservatively in appropriately selected patients. This study aimed to investigate health outcomes in women aged 18-24 years with biopsy-confirmed CIN2. MATERIAL AND METHODS: A retrospective cohort study of Western Australian women aged 18-24 years diagnosed with CIN2 on cervical biopsy from 1 January 2001 to 31 December 2010. Women who had not received treatment at ≥4 months following CIN2 diagnosis were classified as managed 'conservatively'. Subsequent cervical cytology and/or biopsy test results were used to report lesion regression (absence of dysplasia or an epithelial lesion of lower grade than CIN2) and disease persistence (CIN2, CIN3 or ACIS). RESULTS: Follow-up data were available for 2417 women of whom 924 (38.2%) were 'conservatively' managed. In all, 152 (16.4%) conservatively managed women had a lesion more severe than CIN2 detected within 24 months of initial diagnosis, of which 144 were CIN3 and eight were ACIS. There was no statistically significant association between rates of regression and patient age, Socio-economic Indexes for Areas or Accessibility/Remoteness Index of Australia indices. The 2-year regression rate for CIN2 was estimated to be 59.5% (95%CI 0.5-0.6) in this cohort of women. CONCLUSION: In conservatively managed young women with CIN2 there was a high rate of spontaneous disease regression. Thus, excisional or ablative treatments may be avoided in selected patients who receive appropriate counseling and who are able to comply with more intensive and prolonged follow-up requirements.
Authors: Karoliina Tainio; Antonios Athanasiou; Kari A O Tikkinen; Riikka Aaltonen; Jovita Cárdenas; Sivan Glazer-Livson; Maija Jakobsson; Kirsi Joronen; Mari Kiviharju; Karolina Louvanto; Sanna Oksjoki; Riikka Tähtinen; Seppo Virtanen; Pekka Nieminen; Maria Kyrgiou; Ilkka Kalliala Journal: BMJ Date: 2018-02-27