Article

Cervical intraepithelial neoplasia outcomes after treatment: long-term follow-up from the British Columbia Cohort Study

Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA 95817, USA.
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 06/2009; 101(10):721-8. DOI: 10.1093/jnci/djp089
Source: PubMed

ABSTRACT Information on the long-term risk of cervical intraepithelial neoplasia (CIN) recurrence among women treated for CIN is limited yet critical for evidence-based surveillance recommendations.
We retrospectively identified 37,142 women treated for CIN 1, 2, or 3 from January 1, 1986, through December 31, 2000 (CIN cohort), from the British Columbia Cancer Agency cytology database and linked their records with cancer registry and vital statistics data. Treatment included cryotherapy, loop electrosurgical excision procedure, cone biopsy, and laser vaporization or excision. A comparison cohort contained 71,213 women with normal cytology and no previous CIN diagnosis. Follow-up continued through December 31, 2004. Among women in both cohorts under active surveillance, we compared rates of CIN 2 or 3 (CIN 2/3) and cervical cancer. Cumulative incidence rates of CIN 2/3 and 95% confidence intervals (CIs) were estimated by a life table approach by using annual rates. Cumulative rates of invasive cancer were examined by the person-years method.
Overall observed cumulative rates of CIN 2/3 in the first 6 years after treatment were 14.0% (95% CI = 13.84% to 14.15%) for women originally treated for CIN 3, 9.3% (95% CI = 9.09% to 9.42%) for CIN 2, and 5.6% (95% CI = 4.91% to 5.21%) for CIN 1. Annual rates of CIN 2/3 were less than 1% after 6 years. Initial diagnosis, age, and treatment type were associated with a diagnosis of CIN 2/3 after treatment, with 6-year adjusted rates for women aged 40-49 years ranging from 2.6% (95% CI = 1.9% to 3.4%) for treatment of CIN 1 with the loop electrosurgical excision procedure to 34.0% (95% CI = 30.9% to 37.1%) for treatment of CIN 3 with cryotherapy. Overall incidence of invasive cancer (per 100,000 woman-years) was higher in the CIN cohort (37 invasive cancers, 95% CI = 30.6 to 42.5 cancers) than in the comparison cohort (six cancers, 95% CI = 4.3 to 7.7 cancers). Cryotherapy, compared with other treatments, was associated with the highest rate of subsequent disease (adjusted odds ratio for invasive cancer = 2.98, 95% CI = 2.09 to 4.60).
Risk of CIN 2/3 after treatment was associated with initial CIN grade, treatment type, and age. Long-term risk of invasive cancer remained higher among women treated for CIN, particularly those treated with cryotherapy.

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    • "No cases of invasive squamous or adenocarcinoma were recorded during the long-term follow-up. The most used treatment modality was loop electrosurgical excision procedure (LEEP), personalized and performed by highly experienced personnel; the 8.8% rate of residual/recurrent high-grade lesions was at the lower end of the 5–30% published rates [4] [20]. The risk to develop invasive cervical disease in women treated for a high-grade lesion has been reported to persist for many years [5] [6] [21]. "
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    ABSTRACT: Background. The aim of this retrospective observational study of women treated for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was to assess the long-term risk of residual/recurrent high-grade CIN. Materials and Methods. We evaluated 760 women treated by loop electrosurgical excision procedure (684) or conization (76) between 2000 and 2009, and followed up to June 30, 2014 (median follow-up 6.7 years, range 4-14). Visits every 6 months for the first year after treatment and yearly for up to the following 10 years included cytology, colposcopy when indicated, and HPV testing (search and typing). Results. CIN2+ or vaginal intraepithelial neoplasia grade 2 or worse (VAIN2+) was detected in 67 cases (8.8%), 39 at first follow-up and 28 after one/more negative visits. The risk of CIN2+ was higher in case of positive margins (odds ratio (OR) 8.04, 95% CI 4.31-15.0), type 3 transformation zone (OR for CIN3 27.7, 95% CI 2.07-36.9), CIN3+ excision (OR 6.02, 95% CI 1.73-20.9), and positive high-risk HPV test at first follow-up (OR for HPV16: 20.6, 95% CI 6.8-62.6; OR for other hrHPV types: 18.3, 95% CI 5.9-57.0). Conclusion. Residual/recurrent high-grade CIN occurred in <9% cases, and the risk was associated with transformation zone type, lesion grade, margins status, and hrHPV test result at 6-12 months of follow-up.
    01/2015; 2015:1-8. DOI:10.1155/2015/984528
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    • "A significant advantage of LEEP is the ability to examine a tissue sample histologically; however, in areas with few resources, pathological evaluation is usually not available. Studies have generally found LEEP to be associated with somewhat higher cure rates (absence of persistent or recurrent disease) than cryotherapy (Melnikow et al. 2009). A randomized clinical trial of cryotherapy and LEEP for treatment of histologically confirmed high-grade cervical dysplasia found that LEEP had higher overall cure rate of 96.4% as compared to 88.3% for cryotherapy (p=0.026) "
    Cancer Prevention - From Mechanisms to Translational Benefits, 04/2012; , ISBN: 978-953-51-0547-3
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