The hazards of active monitoring for cervical intraepithelial neoplasia grade 2 (CIN2), a precursor to cervical cancer, were evaluated in a landmark study conducted by Danish researchers. LLETZ, or large loop excision of the transformation zone, is the conventional surgical approach for CIN2 treatment.
The ultimate goal is to keep the disease from developing into cancer. Concerns about possible overtreatment, particularly among younger women, have prompted some countries to implement active monitoring programs. Using data from trustworthy Danish registries, the research discovered some striking results.
The findings show that women who have active CIN2 monitoring are almost four times more likely to acquire cervical cancer over 20 years than those who receive LLETZ right away. While the first two years of active monitoring revealed no absolute risk of cervical cancer, there was a considerable rise in risk with time, particularly in women aged 30 and up. Â
The findings of this study call into question what is presently known about active surveillance as a risk-free alternative to quick therapy. The study found that latent HPV infection can persist even if histology shows that the CIN has resolved, even if CIN2 can be followed on a regular basis using active surveillance methods like biopsies and colposcopy. According to the study, women who are actively monitored may be at an even higher risk of cervical cancer than those who undergo LLETZ, on top of the already significant risk that women face throughout their lives. Â
The implications of these findings are significant, emphasizing the significance of treating CIN2 with understanding. Considerations such as age and reproductive goals deserve careful consideration. For pregnant women of reproductive age, active monitoring may be a risk-free choice. According to the study, having an open talk about the long-term risk of cervical cancer is critical once planned pregnancies terminate. This might include contemplating an LLETZ offer after having a kid. Â
Furthermore, the study suggests that women who have previously been closely monitored may require a lower threshold to be administered LLETZ if there is a significant chance of recurrent illness. The study’s finding that active monitoring is connected with higher worry and worries about the progress of the disease emphasizes the need to educate women about the advantages and hazards. Finally, these ground-breaking discoveries will be highly beneficial to healthcare practitioners who assist women with CIN2 diagnoses.
As active monitoring becomes more popular as a feasible alternative to immediate treatment, more research is needed to enhance treatment recommendations and provide the best possible results for women at risk of cervical cancer. The study underlines the dynamic nature of healthcare decision-making and the need for a sophisticated strategy that takes into account individual circumstances as well as long-term consequences. Â
Journal Reference Â
Lycke, K. D., Kahlert, J., Petersen, L. K., Damgaard, R. K., Cheung, L. C., Gravitt, P. E., & Hammer, A. (2023). Untreated cervical intraepithelial neoplasia grade 2 and subsequent risk of cervical cancer: population based cohort study. Retrieved from https://www.bmj.com/content/383/bmj-2023-075925Â
