Watch or Remove? Study Finds One Option May Be Better for Abnormal Cervical Lesions

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Key Takeaways

• Cervical lesions are sometimes found on gynecologic exams, and they can later become cancerous

• A new study finds the longer-term risks of leaving the lesions intact while watching them might outweigh any benefit

• Decisions on whether excision of a CIN2 is preferred may hinge on patient-doctor discussions

When abnormal cervical cells are detected during a gynecological exam, it may be safer to remove them right away rather than “actively survey” the lesions and leave them in place, new research suggests.

In a study of over 27,500 Danish women, those who opted for active surveillance had higher long-term risks for cervical cancer, compared to women who’d had these suspicious lesions removed. 

The study focused on a common, precancerous type of cervical cell growth known as cervical intraepithelial neoplasia grade 2 (CIN2).

The new findings “are important for future guidelines on management of CIN2 and clinical counseling of women with a diagnosis of CIN2,” said a team led by Dr. Anne Hammer, with the department of clinical medicine at Aarhus University in Denmark.

As Hammer’s team explained, there’s been controversy over just what to do about CIN2 lesions once they’ve been detected.

On the one hand, these lesions can be precursors to cervical cancer, although more than half of CIN2 cases also “regress” to a harmless state within two years.   

So, excising all such lesions raises concerns about over-treatment.  

As well, there are connections between the surgical removal of CIN2 lesions and higher odds for preterm birth should a woman become pregnant.

“As a result, many countries have implemented active surveillance as an option in younger women in whom CIN2 is diagnosed,” Hammer and colleagues explained.

Investigating further, they tracked outcomes for 27,500 Danish women aged 18 to 40 who were diagnosed with CIN2 between 1998 and 2020.  

More than half (55%) of these women underwent immediate removal of any CIN2 lesions, while the remainder of the women opted for “active surveillance,” with periodic follow-up exams.

Tracked to the end of 2020, 104 cases of cervical cancer emerged among the full cohort — 56 in the active surveillance group and 48 among those women who had their lesions removed.

Two years after diagnosis, the odds of cervical cancer developing were similar, regardless of whether the women had lesion removal surgery or not, Hammers team noted.

But over the longer term, differences emerged.

By 20 years post-diagnosis, women in the active surveillance group had four times the risk of developing cervical cancer compared to women who’d had their CIN2 removed. 

The study was published Nov. 29 in the BMJ.

According to the researchers, HPV (the virus behind most cases of cervical cancer) may be less active in women who get CIN2 lesions removed right away.  In cases where lesions are left intact, HPV might reactivate over time and trigger cancers, the team reasoned. 

Hammer’s group stressed that, regardless of the treatment received, the absolute risk to any one patient of developing a cervical cancer remained very low. 

Nevertheless, “our findings suggest the need for a decision-making process for treatment of CIN2 based on age and reproductive desire,” Hammer’s team concluded. 

They now believe that “active surveillance for two years seems to be safe in terms of risk of cancer for women who are planning pregnancy [both younger and older women]. However, once women having active surveillance have completed their planned pregnancies, a shared discussion of long term risk of cervical cancer may be warranted.”

More information

Find out more about CIN2 at the Cleveland Clinic.

SOURCE: BMJ, Nov. 29, 2023

What This Means For You

If a gynecologic exam turns up a precancerous lesion known as CIN2, immediate excision might be the better option, new research suggests

Source: HealthDay

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