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    Study: Active surveillance of CIN2 a viable treatment

    According to a systematic review and meta-analysis published in The BMJ, active surveillance is an appropriate treatment plan for moderate cervical lesions, often called cervical intra-epithelial neoplasia grade 2 (CIN2). The data show that in young women, particularly those under age 30, lesions often regress, supporting a conservative approach.

    To assess rates of spontaneous regression of CIN2, the authors looked at results from 36 studies involving 3160 women who had a laboratory confirmed diagnosis and had been actively monitored for at least 3 months. Taking study design and quality differences into account, rates of regression, persistence and progression were measured at 3, 6, 12, 24, 36, and 60 months. After 2 years, half (50%) the lesions had regressed spontaneously, one-third (32%) persisted, and one-fifth (18%) progressed. In women under age 30, the regression rate was even higher (60%), while persistence (23%) and progression (11%) were both lower. Only 15 cases of cancer were reported (0.5%), and most of these diagnoses were in women over 30. Surveillance compliance rates were high (approximately 90% over 2 years) and similar results emerged after further analysis to test the strength of the findings.

    The researchers noted some limitations of their report, primarily substantial differences between the studies included and possible misclassification of lesions. The strengths of their work, they said, were the comprehensive literature search done to select the reports analyzed, duplicate assessment of eligibility and data abstraction, and appraisal of risk bias. One other point raised was that the inclusion and exclusion criteria varied greatly across the original studies, which may have been a strength because it may have increased the applicability of the results, but also a limitation in that it may have affected the selection of women with CIN2 lesions to be treated with active surveillance and introduced bias. Ultimately, the authors concluded that their analysis shows that women under age 30 with a CIN2 diagnosis can be treated with active surveillance but their results should be interpreted with caution.

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is an editorial consultant for Contemporary OB/GYN.
    Ben Schwartz
    Ben Schwartz is Associate Editor, Contemporary OB/GYN.


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