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Risk of Cervical Intraepithelial Neoplasia 2+ Among Women With a History of Previous Treatment for Cervical Intraepithelial Neoplasia: ASCUS and LSIL Pap Smears After Treatment

Burks, Heather R. MD1; Smith, Katherine M. MD1; Wentzensen, Nicolas MD, PhD, MS2; Tenney, Meaghan MD1; Tuller, Erin MD1; Moxley, Katherine MD1; Mathews, Cara MD1; Dunn, S. Terrence1; Wang, Sophia S.2; Gold, Michael A. MD3

Journal of Lower Genital Tract Disease: January 2011 - Volume 15 - Issue 1 - p 11-14
doi: 10.1097/LGT.0b013e3181ed3d6d
Original Articles

Objective. The objective of the current study was to describe outcomes among women with low-grade abnormalities on cervical cytology screening in the setting of previous excisional or ablative treatment for cervical intraepithelial neoplasia (CIN).

Methods. Study participants were recruited into the Study to Understand Cervical Cancer Early Endpoints and Determinants. At enrollment, the patient's previous cytology results, previous colposcopic biopsy results, and previous cervical procedures were recorded. Study procedures included collection of biospecimens followed by colposcopy and biopsy. From clinical records, additional information regarding previous treatment for CIN was collected.

Results. Two hundred seventy-four women had an atypical squamous cells of uncertain significance (ASCUS) referral Pap and 532 women had a low-grade squamous intraepithelial lesion (LSIL) referral Pap. For patients with an ASCUS referral Pap, previous treatment was associated with an odds ratio for CIN 2+ (45.0% vs 28.2% of untreated patients) of 2.08 (95% confidence interval = 1.05-4.13, p = .04). For patients with an LSIL referral Pap, 33.3% of those women with previous treatment had CIN 2+ compared with 16.7% of those patients enrolled with no previous treatment (odds ratio = 2.49, 95% confidence interval = 1.12-5.51, p = .03).

Conclusions. Patients with a history of previous treatment for CIN have a 2-fold risk of CIN 2+ at the time of colposcopy referral for ASCUS or LSIL cervical cytology.

Previous excisional treatment for cervical intraepithelial neoplasia increases the risk of CIN 2 or greater associated with an ASCUS or LSIL Pap smear.

1Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; and 3Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN

Reprint requests to: Heather R. Burks, MD, 920 SL Young Blvd, WP 2410, Oklahoma City, OK 73104. E-mail:

This research was supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute.

©2011The American Society for Colposcopy and Cervical Pathology