RESEARCHERS from Aarhus University, Denmark, have found that females undergoing active surveillance for cervical intraepithelial neoplasia Grade 2 (CIN2) face an elevated long-term risk of cervical cancer, compared to those opting for immediate treatment.
The nationwide, population-based, historical cohort study, led by Kathrine Dyhr Lycke, Gødstrup Hospital, Herning, Denmark, included 27,524 females diagnosed with CIN2 between 1998–2020. Participants, aged 18–40 years at diagnosis, were either placed on active surveillance or received immediate treatment involving a large loop excision of the transformation zone. In the cohort, 45% of females had active cervical lesion surveillance and 55% had immediate treatment.
The primary outcome investigated was the long-term risk for cervical cancer. Over the follow-up period, 104 cervical cancer cases were identified, with 54% originating from the active surveillance group, and 46% from the immediate treatment group. Noteworthy shifts in the management approach were observed over the years. Between 1998–2012, 66% of females underwent immediate treatment. However, this increased after 2012, with 68% of females opting for active surveillance.
Furthermore, during the initial 2-year active surveillance period, the cumulative cervical cancer risk was comparable between the two groups. The active surveillance group exhibited a risk of 0.56%, slightly higher than the 0.37% in the immediate treatment group. However, over the 20-year follow-up, the risk dramatically increased in the active surveillance group, reaching 2.65%, while the immediate treatment group maintained a stable risk of 0.76%.
The researchers emphasised the significance of their findings for shaping future guidelines on managing CIN2, and providing crucial insights for clinical counselling of females facing a CIN2 diagnosis. This study also raises important questions about the long-term efficacy of active surveillance, and prompts a re-evaluation of current protocols for managing CIN2, ultimately aiming to enhance the preventive strategies against cervical cancer.
