Role of different etiological factors in progression of cervical intraepithelial neoplasia

Implication of high risk-human Papillomavirus in the process of cervical carcinogenesis is well documented. However, carcinogenesis in the cervix is recognized as multifactorial and other unknown etiological factors are also presumed to contribute to development of cancer. The present communication was aimed to investigate the role of risk factors such as age, parity, cervical lesions, and gynecological symptoms in the progression of the intra-epithelial cervical neoplasia. The study followed 571 cytologically diagnosed cases of high-grade squamous intraepithelial lesions (HSIL) during 35 yr of cytological screening, which is in progress at Gynae OPD of Queen Mary's Hospital of the University since April 1971 and until June 2005, a total of 33,658 cervical smears have been cytologically evaluated. Analysis of different risk factors in 571 HSIL cases revealed high parity coupled with increasing age to play a significant role in the progression of SIL. Further aggravated cervical lesions such as suspicious and unhealthy cervix and persistent vaginal discharge were found to be contributing factor in the progression of SIL. All these factors were predominantly seen in 35 cases of severe dysplasia that have shown progression from moderate dysplasia. The study indicates that women of high parity, especially with high age, are more prone to progression of SIL and hence this group needs mandatory cytological evaluation. Further adequate treatment of mild cervical lesions and persistent vaginal discharge is necessary to avoid the aggravation of the lesion/symptom and subsequent progression of dysplasia.