Editorials

Safety of modern treatment for cervical pre-cancer

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6611 (Published 05 November 2014) Cite this as: BMJ 2014;349:g6611
  1. Björn Strander, director1, consultant2,
  2. Jan Adolfsson, associate professor of urology34
  1. 1Cervical Screening, Regional Cancer Centre, West Sweden
  2. 2Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  3. 3SBU-Swedish Council on Health Technology Assessment, Stockholm, Sweden
  4. 4Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to: bjorn.strander{at}rccvast.se

Most women can be reassured about future pregnancies

“Will this affect my ability to become pregnant?” might be the most common question asked by women recommended treatment for cervical intraepithelial neoplasia (CIN). Attempting to answer this question, among others, two linked papers (doi:10.1136/bmj.g6192, doi:10.1136/bmj.g6223) cover a range of potential harms to human reproduction associated with treatments for CIN, including fertility.1 2

Kyrgiou and colleagues’ meta-analysis of 15 cohort studies found no evidence that large loop excision of the transformational zone or any other procedure impairs fertility or increases the risk of early spontaneous pregnancy loss.1 Treated women did have a higher risk of second trimester miscarriage than controls. They also had more pregnancies, ectopic pregnancies, and terminations than controls, suggesting unadjusted differences between groups in sexual behaviour or other lifestyle confounders.

Finding an appropriate control group is a recurring problem for researchers trying to evaluate the possible reproductive harms of treatments for CIN. Castanon and colleagues report an association between risk of preterm birth and large, but not small, excisions of the cervical transformation zone.2 They attempted to overcome the problem of control groups by …

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