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Friday, May 31, 2013
Trailers (50): See-and-treat for CIN

Bosgraaf et al. Overtreatment in a see-and-treat approach to cervical intraepithelial lesions.

Why should you read about this topic?

See-and-treat might be a more efficient approach to high-grade or persistent cervical lesions but at the expense of   overtreatment.

What were the authors trying to do?

To estimate the rate of overtreatment in a see-and-treat protocol for cervical dysplasia

Who participated and in what setting?

Women (N=3192) with abnormal Pap smears who underwent a see-and-treat protocol at the Radboud University Nijmegen Medical Center between 1981-2010

What was the study design?

Retrospective database study

What were the main outcome measures?

Overtreatment (CIN 1 or less at final histopathologic analysis)

What were the results?

18% of women were overtreated.  The lowest overtreatment rate was in women with a high-grade smear and a high-grade colposcopic impression.  The older the woman the greater the rate of overtreatment.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: large study size. Weaknesses: database study; long period of study spanning many significant changes in cervical cancer screening; no cytopathology or histopathology review; missing data in over 25%

What does the study contribute for your practice?

See-and-treat seems to work best when you have a colposcopic impression of a high-grade lesion along with a high-grade Pap smear.  Now what we need is a cost-effectiveness analysis of see-and-treat that includes costs of overtreatment.

About the Author

William C. Dodson, MD
William C. Dodson, MD, is Professor of Obstetrics and Gynecology and Director of the Division of Reproductive Endocrinology and Infertility at Penn State College of Medicine. He completed his fellowship in reproductive endocrinology at Duke University. His research and clinical areas of focus include treatment of infertility, especially ovulation induction. He was previously on the Editorial Board of Obstetrics & Gynecology and has served as the Consultant Web Editor for Obstetrics & Gynecology since 2008.