Actively monitoring cervical lesions increases long-term cervical cancer risk

Key takeaways:

• After 20 years, cervical cancer risk increased in the active surveillance group but remained stable in the immediate treatment group.
• Cervical cancer risk was similar between the two groups in the first 2 years.

Women who underwent active surveillance for cervical intraepithelial neoplasia grade 2 had an increased long-term risk for cervical cancer compared with women who received immediate treatment, according to findings published in The BMJ.

“Active surveillance has been an option in Denmark since 2013 and in some Danish regions since 1995,” Katherine Dyhr Lycke, a PhD student in the department of obstetrics and gynecology at Gødstrup Hospital and the department of clinical medicine at Aarhus University, Denmark, and colleagues wrote. “Thus, using data from high quality and individual level Danish registries, we aimed to describe the 20-year cumulative risk of cervical cancer in women having active surveillance for cervical intraepithelial neoplasia grade 2 compared with women treated with immediate large loop excision of the transformation zone.”

Dyhr Lycke and colleagues conducted a nationwide population-based historical cohort study with 27,524 women with cervical intraepithelial neoplasia grade 2 (CIN2). All women were diagnosed between 1998 and 2020 and were aged 18 to 40 years at diagnosis. Participants underwent either active surveillance or immediate treatment with large loop excision of the transformation zone.

The primary outcome was the long-term risk for cervical cancer.

In the cohort, 45% of women had active cervical lesion surveillance and 55% had immediate treatment. During the follow-up period, researchers identified 104 cervical cancer cases, of which 54% were from the active surveillance group and 46% were from the immediate treatment group. From 1998 to 2012, 66% of women had immediate treatment; after 2012, 68% of women had active surveillance.

Across the two groups, the cumulative cervical cancer risk was comparable during the active surveillance period of 2 years, with a risk of 0.56% in the active surveillance group and 0.37% in the immediate treatment group. However, cervical cancer risk increased to 2.65% in the active surveillance group after 20 years of follow-up. Cervical cancer risk remained stable in the immediate treatment group (0.76%).

“Our findings are important for future guidelines on management of CIN2 and clinical counseling of women with a diagnosis of CIN2,” the researchers wrote.