Cervical cancer risk remains high after CIN treatment

Women who undergo treatment for screening-detected cervical intraepithelial neoplasia (CIN) are more than four times more likely to develop cervical cancer than women with normal smear tests, research suggests.

Twenty cervical cancers were detected among the 56,956 Dutch women who completed treatment for CIN grade 1 to 3 disease and had three clear follow-up smears compared with 1613 cervical cancers among 25,020,657 women with healthy cervical cytology, report Matejka Rebolj (Erasmus Medical Center, Rotterdam, the Netherlands) and co-authors.

This gave a cervical cancer incidence among CIN cases and controls of 35.1 versus 6.4 cases per 100,000 woman-years (adjusted hazard ratio=4.2).

The risk for cervical cancer after CIN treatment was not influenced by patient age or CIN grade.

"These results have implications for women treated for [CIN], although how the excess risk could be decreased is not straightforward," Rebolj et al comment in the BMJ.

A second article in the same issue, by Rosa Legood (London School of Hygiene and Tropical Medicine, UK) and co-authors, supports testing for the papillomavirus after treatment for CIN 3+ disease.

Using epidemiologic data from the English National Health Service Cervical Cancer Screening Programme, the researchers showed that a "test for cure" of the virus would prevent 8.4 more cases of recurrent CIN 3+ disease per 1000 women treated than follow up with cytology alone, and significantly reduce treatment costs.

In an editorial accompanying the two research papers, Maaike Bleeker (VU Medical Center, Amsterdam, the Netherlands) and co-authors question whether short-term surveillance guidelines after CIN 3 treatment, which currently recommend a patient returns to the regular screening program after achieving negative cytology results 6, 12, and 24 months after treatment, is adequate.

"Sufficient evidence exists for current guidelines on surveillance of women treated for CIN to be modified," they say.

"Short-term monitoring post-treatment of women with combined HPV testing and cytology at 6 months and 24 months seems to be sufficient to detect post-treatment cervical disease. After this time, adequate follow-up would be provided by a return to the national screening programme."

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