ArticlesInvasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia
Introduction
The objective of treatment of cervical intraepithelial neoplasia (CIN) is the prevention of invasive squamous-cell carcinoma of the cervix. Treatments have evolved over the years from inpatient surgery, such as radical hysterectomy, hysterectomy, and knife-cone biopsy, to conservative therapy for suitable outpatients with laser, cryotherapy, cold coagulation, or diathermy. Because of the risk of inadvertently treating invasive disease, ablative techniques for outpatients with CIN have given way to excisional treatment with laser or diathermy.
Long-term follow-up of women who have undergone hysterectomy or knife-cone biopsy for CIN suggests that although these procedures are effective, some patients have late recurrences.1, 2, 3, 4, 5 Few studies have used life-table methods to take account of the reducing numbers of patients as the length of follow-up increases.1, 2, 3, 4
The follow-up periods of most studies of the efficacy of conservative outpatient treatments rarely exceed 1 year. To the best of our knowledge, there have been only six long-term studies of such treatments for CIN, in which the data were analysed by life-table methods.6, 7, 8, 9, 10, 11 We combined data from the five studies in the UK6, 7, 8, 9, 10 and new, hitherto unpublished, information was added.
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Methods
The studies were based at four UK centres in Sheffield, Gateshead, Aberdeen, and Dundee. Data from the five UK studies were made available for our analysis.6, 7, 8, 9, 10 If the number of woman-years of follow-up was not published, we calculated it by re-examining the original data. Data was obtained for the time from treatment of CIN to the development of invasive cervical cancer. We collected further follow-up data for the laser vaporisation series from Gateshead. Unpublished data for women
Results
Data were available from six groups of patients (table 1). The Sheffield series (group SV) comprised 328 women who had been treated with laser vaporisation and ten women who had undergone laser excision between 1980 and 1984.6 The Gateshead laser vaporisation series (group GV) comprised 4464 women who had been treated for CIN between 1978 and 1990. Data from 4222 of these women have been reported.7 Data from the Gateshead laser cone series (group GC) and the Gateshead loop series (group GL)
Discussion
Our study is unique because of the large number of women included in the analysis and the long duration of follow-up. Furthermore, the value of our - findings is increased by the heterogeneity of the data from four institutions in the UK that serve different populations.
Potential limitations of combining data from these studies are differences in the age distribution of the women and in the length and methods of follow-up between the studies. These data may also be affected by possible
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2020, Gynecologic OncologyCitation Excerpt :Approximately 10% of the women treated for CIN lesions, show high-grade disease within the first two years of follow-up, defined as residual disease [14]. This rate of residual disease indicates the importance of follow-up post-treatment, but women possibly remain at an increased risk of developing cervical cancer for a longer period of time [5–9]. This might be explained by the susceptibility for reinfection with hrHPV and a lower capability to clear the infection (latent infection), which could lead to more de novo CIN lesions [15–19].
Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature
2020, Annals of OncologyCitation Excerpt :Although local cervical treatment of CIN is highly efficacious, treated women continue to represent a high-risk group, as the recurrence rate for high-grade preinvasive disease can be as high as 5%–10%.3 Furthermore, and despite increased surveillance, these women have been reported to have a higher risk of invasive cervical cancer than the general population for several years after treatment.4–8 The impact of different treatment methods (excisional or ablative) on the risk of future invasion remains largely unclear.