Clinical outcomes after conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in Women Ages 21-39 Years

Michelle I. Silver, Julia C. Gage, Mark Schiffman, Barbara Fetterman, Nancy E. Poitras, Thomas Lorey, Li C. Cheung, Hormuzd A. Katki, Alexander Locke, Walter K. Kinney, Philip E. Castle

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)165-170
Number of pages6
JournalCancer Prevention Research
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018

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Cervical Intraepithelial Neoplasia
Cell Biology
Colposcopy
Clinical Protocols
Neoplasms
Conservative Treatment
Obstetrics
Histology
Cohort Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Clinical outcomes after conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in Women Ages 21-39 Years. / Silver, Michelle I.; Gage, Julia C.; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Katki, Hormuzd A.; Locke, Alexander; Kinney, Walter K.; Castle, Philip E.

In: Cancer Prevention Research, Vol. 11, No. 3, 01.03.2018, p. 165-170.

Research output: Contribution to journalArticle

Silver, MI, Gage, JC, Schiffman, M, Fetterman, B, Poitras, NE, Lorey, T, Cheung, LC, Katki, HA, Locke, A, Kinney, WK & Castle, PE 2018, 'Clinical outcomes after conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in Women Ages 21-39 Years', Cancer Prevention Research, vol. 11, no. 3, pp. 165-170. https://doi.org/10.1158/1940-6207.CAPR-17-0293
Silver, Michelle I. ; Gage, Julia C. ; Schiffman, Mark ; Fetterman, Barbara ; Poitras, Nancy E. ; Lorey, Thomas ; Cheung, Li C. ; Katki, Hormuzd A. ; Locke, Alexander ; Kinney, Walter K. ; Castle, Philip E. / Clinical outcomes after conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in Women Ages 21-39 Years. In: Cancer Prevention Research. 2018 ; Vol. 11, No. 3. pp. 165-170.
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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.",
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