Conservative management of CIN2 being investigated

The researchers want to find out if monitoring and observing CIN2 in young women, rather than treating with surgery, will result in fewer treatment-related adverse outcomes for women under 25 years with CIN2.

Peter Sykes says evidence shows a significant number of cases of CIN2 in young women will either spontaneously lessen in severity or resolve themselves completely, which means treatment for all CIN2 lesions may not be needed.

“A number of international studies indicate there is marginal benefit from screening women under the age of 25,” he says.  “The younger you are, the more likely you are to have an abnormality but many of these regress on their own accord.

“That’s different from CIN3, which are high-grade abnormalities that are more likely to become cancerous and therefore require aggressive treatment, and from the lower grade CIN1 which we don’t usually treat because these mostly resolve by themselves.”

Historically no clear distinction had been made between CIN2 and CIN3, with both described as high grade abnormalities, but Peter Sykes says many doctors believe there is a role for conservative management of CIN2 in young women.   This was supported by the results of a retrospective study carried out by his research team, published in the American Journal of Obstetrics & Gynaecology in November 2011.

“The problem we have, however, is the lack of solid evidence on which to base routine practice,” he says.  “We’re hoping our new prospective study will provide that evidence.”

The new study involves observing 600 women aged under 25 with biopsy-proven CIN2 over a period of two years, with regular colposcopies and cervical biopsies carried out to see if the abnormality changes or remains the same.  Peter Sykes hopes the study will also pinpoint the factors that predict when CIN2 will change for the better.

“If what we learn helps women avoid unnecessary surgery for CIN2, that would be great,” he says. “There is some evidence, for example, that as well as immediate complications from surgery, cervical treatments can have an adverse effect on pregnancy outcomes.”

The study is being carried out by the University of Otago (Christchurch), with funding from the university, Gynaecological Cancer Research Trust, and the Cancer Society of New Zealand (Canterbury West Coast Division).   Thirteen hospitals are currently taking part in the study, or planning to, and 150 participants have been recruited so far.