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Regression and Progression Predictors of CIN2 in Women Younger Than 25 Years

Loopik, Diede L. MSc; Doucette, Steve MSc; Bekkers, Ruud L.M. MD, PhD; Bentley, James R. MBChB, FRCSC

Journal of Lower Genital Tract Disease: July 2016 - Volume 20 - Issue 3 - p 213–217
doi: 10.1097/LGT.0000000000000215
Original Research Articles: Cervix and HPV

Objective The purpose of this study was to review the management and outcome of cervical intraepithelial neoplasia 2 (CIN2) in women younger than 25 years.

Methods A retrospective review was performed, investigating women younger than 25 years at the time of diagnosis with biopsy-proven CIN2 between January 1, 2010, and December 31, 2014, who were seen in the colposcopy clinic at the Queen Elizabeth II Hospital in Halifax, Nova Scotia, Canada. The regression, persistence, and progression rate of CIN2 in conservative managed women were evaluated, and potential risk factors were examined. Colposcopy, cytologic, and histopathologic findings were compared with women with immediate treatment (<6 months).

Results Of the 319 women included in the study, 108 women received immediate treatment, and 211 women were managed conservatively; of these, 144 women remained untreated, and 67 women received treatment 6 months or greater. From the women managed conservatively, 150 women (71.1%) showed regression, 26 women (12.3%) had persistent disease, and 35 women (16.6%) progressed, with a median follow-up of 15.1 months. None of the women included in the study progressed to invasive cancer. The hazard ratio for time to progression was 2.40 for women who smoked (p = 0.006).

Conclusions A conservative approach of CIN2 is the preferred management option for women younger than 25 years. Smoking was identified as a risk factor for progression.

Based on high regression rates, conservative management of CIN2 is the preferred option for women younger than 25 years.

1Radboud University, Nijmegen, The Netherlands; 2Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; 3Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, The Netherlands; and 4Department of Obstetrics and Gynecology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

Correspondence to: James R. Bentley, MBChB, FRCSC, Division Head of Gynecologic Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. E-mail:

Statement of authorship: All the authors have made substantial contributions to the conception and design of the work or the acquisition, analysis, or interpretation of data for the work. They have participated in drafting the manuscript and approval of the version to be published.

Disclosure of source(s) of financial support: This research was not funded.

Declaration of Interests: No authors have any financial or personal relationships with other people or organizations that could inappropriately bias their work. The authors have declared they have no conflicts of interest.

Ethical adherence: The authors report adherence to ethical standards in the conception of the work, data collection, and writing of the manuscript.

IRB status: The research ethics board of the Nova Scotia Health Authority granted approval before the study began.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology