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Outcomes After Management of Young Women With Cervical Intraepithelial Neoplasia 2 With a 6-Month Observation Protocol

Bleecker, Elizabeth MD1; Koehler, Elizabeth MS2; Smith, Jennifer PhD3; Budwit, Debra MD4; Rahangdale, Lisa MD, MPH1

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 46–49
doi: 10.1097/LGT.0b013e3182901ef3
Original Articles

Objective Recommendations regarding treatment of cervical intraepithelial neoplasia (CIN) 2 in women have evolved over the years: young women with CIN 2 may be offered observation with Pap smears and colposcopy every 6 months instead of immediate excision or ablation of disease. The purpose of this study was to observe patient follow-up during the initiation of this management protocol for young women with CIN 2.

Materials and Methods This was a retrospective review of clinical outcomes of women younger than 30 years with CIN 2 on index biopsy and planned follow-up at UNC between July 2009 and August 2010. A chart review for clinical variables, follow-up visits, and progression of disease was conducted. Primary analysis determined the rate of follow-up and pathology at 6 months. Secondary analysis investigated risk factors for incomplete follow-up.

Results Seventy women met inclusion criteria; 46 were managed with observation. Twenty-eight (60.8%; 28/46) women completed a follow-up visit. Demographic and clinical variables did not reach statistical significance in predicting the likelihood of completion of a follow-up visit, although there was a trend toward greater follow-up in employed patients (odds ratio = 5.25, 95% confidence interval = 0.84–34.78). Approximately half (52.4%; 11/21) of women with a completed cervical biopsy demonstrated regression of disease during the study period.

Conclusions On the basis of these data, follow-up in this population was unpredictable based on basic demographic or clinical factors that we often use to judge likelihood of compliance with medical recommendations. The percentage of patients with regression at follow-up was as expected from the natural history of CIN 2.

Women with CIN 2 were managed with observation rather than immediate treatment; however, there was no single factor predictive of patient follow-up.

Departments of 1Obstetrics and Gynecology, 2Biostatistics, 3Epidemiology, and 4Pathology, University of North Carolina, Chapel Hill, NC

Reprint requests to: Elizabeth Bleecker, MD, 33 W Ontario St, Apt 37D, Chicago, IL, 60654. E-mail:

The authors received financial support from the University of North Carolina University Research Counsel Award. Dr Rahangdale has received research supplies from Hologic and QIAGEN.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology