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Risk Factors for Persistent Cervical Intraepithelial Neoplasia Grades 1 and 2: Managed by Watchful Waiting

Ho, Gloria Y.F. PhD1; Einstein, Mark H. MD2; Romney, Seymour L. MD✠2; Kadish, Anna S. MD3; Abadi, Maria MD3; Mikhail, Magdy MD5; Basu, Jayasri PhD2; Thysen, Benjamin PhD2; Reimers, Laura MPH4; Palan, Prabhudas R. PhD5; Trim, Shelly PhD1; Soroudi, Nafisseh PhD1; The Albert Einstein Cervix Dysplasia Clinical Consortium; Burk, Robert D. MD4

Journal of Lower Genital Tract Disease: October 2011 - Volume 15 - Issue 4 - pp 268-275
doi: 10.1097/LGT.0b013e3182216fef
Original Articles

Objective: This study examines risk factors for persistent cervical intraepithelial neoplasia (CIN) and examines whether human papillomavirus (HPV) testing predicts persistent lesions.

Materials and Methods: Women with histologically diagnosed CIN 1 or CIN 2 (n = 206) were followed up every 3 months without treatment. Human papillomavirus genotyping, plasma levels of ascorbic acid, and red blood cell folate levels were obtained. Cervical biopsy at 12 months determined the presence of CIN. Relative risk (RR) was estimated by log-linked binomial regression models.

Results: At 12 months, 70% of CIN 1 versus 54% of CIN 2 lesions spontaneously regressed (p < .001). Levels of folate or ascorbic acid were not associated with persistent CIN at 12 months. Compared with HPV-negative women, those with multiple HPV types (RRs ranged from 1.68 to 2.17 at each follow-up visit) or high-risk types (RRs range = 1.74-2.09) were at increased risk for persistent CIN; women with HPV-16/18 had the highest risk (RRs range = 1.91-2.21). Persistent infection with a high-risk type was also associated with persistent CIN (RRs range = 1.50-2.35). Typing for high-risk HPVs at 6 months only had a sensitivity of 46% in predicting persistence of any lesions at 12 months.

Conclusions: Spontaneous regression of CIN 1 and 2 occurs frequently within 12 months. Human papillomavirus infection is the major risk factor for persistent CIN. However, HPV testing cannot reliably predict persistence of any lesion.

Human papillomavirus is the major risk factor for persistent cervical intraepithelial neoplasia, but human papillomavirus testing has limited value in predicting persistent lesions, particularly the equivocal cervical intraepithelial neoplasia 1.

Departments of 1Epidemiology & Population Health, 2Obstetrics & Gynecology, 3Pathology, 4Pediatrics, Albert Einstein College of Medicine; and 5Bronx Lebanon Hospital, Bronx, NY

Correspondence to: Gloria Y.F. Ho, PhD, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Belfer #1312, 1300 Morris Park Ave, Bronx, NY 10461. E-mail:

This study was funded by the National Cancer Institute, National Institutes of Health grant R01-64247 (to Dr Ho).

The Albert Einstein Cervix Dysplasia Clinical Consortium: Patrick S. Anderson,Laurie Budnick, Ronald Burke, Hector Cabot, Ilana Cass, Juana Hutchinson-Colas, Heidi DuPret, Abbie L. Fields, Larry Ham, Marianne Hennessy, Olga Kaali, Jean Murphy, Serge Nazon, Masooma Niazi, Deborah Ottenheimer, Iliana Robinson, Natalie Roche, Carolyn D. Runowicz, Lesly Sainvil, Carlos Simbala, Patrick F. Timmins, and Daryl Wieland.


©2011The American Society for Colposcopy and Cervical Pathology