Treatment or surveillance for CIN2?

When cervical screening is delivered systematically as an organised programme, cervical cancer rates have fallen.1 Even with the introduction of vaccination against human papillomavirus (HPV), which can deliver high levels of protection against cervical cancer, and other HPV related cancers, screening remains important to reduce cervical cancer rates in unimmunised women as well as the risk of cancers attributed to non-vaccine HPV types in all women.

As screening has evolved over time and in different settings, so has our understanding of the clinical course of cervical disease. In this week’s issue, a systematic review and meta-analysis by Tainio and colleagues (doi:10.1136/bmj.k499) provides a more robust prediction of the clinical course and risk of active surveillance for women with cervical intraepithelial neoplasia grade 2 (CIN2).2 The results not only update the available evidence but take on the challenges of bias and other limitations in previous observational studies and trials.

Accurate figures for regression and …