Skip Navigation LinksHome > October 2011 - Volume 15 - Issue 4 > Risk Factors for Persistent Cervical Intraepithelial Neoplas...
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3182216fef
Original Articles

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

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Abstract

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.

©2011The American Society for Colposcopy and Cervical Pathology

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