Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study.

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• High-grade cervical intraepithelial neoplasia (CIN grade 2 or 3) treatment is followed by a 15% risk of residual or recurrent disease or cervical cancer.
• Most post-treatment disease is diagnosed within 2 years, necessitating insight into long-term predictive follow-up strategies.

Purpose of the Study:

• To assess the long-term cumulative risk of post-treatment CIN grade 2 or higher.
• To evaluate the effectiveness of different follow-up algorithms in identifying women at risk of residual or recurrent disease.

Main Methods:

• A cohort of 435 women treated for CIN grade 2 or 3 in the Netherlands between 1988 and 2004 were followed.
• Follow-up included cytology and high-risk human papillomavirus (hrHPV) testing at 6, 12, and 24 months, with subsequent cytological screening every 5 years.
• Cumulative risk of CIN grade 2 or higher was assessed by December 2009, including analyses for women with consecutive negative cytology or negative co-testing results.

Main Results:

• The 5-year cumulative risk of CIN grade 2 or higher was 16.5%, and the 10-year risk was 18.3%.
• For CIN grade 3 or higher, the 5-year risk was 8.6%, and the 10-year risk was 9.2%.
• Women with three consecutive negative cytology smears had a 5-year risk of 2.9% and a 10-year risk of 5.2% for CIN grade 2 or higher. Negative co-testing yielded even lower risks (5-year: 1.0%, 10-year: 3.6%).

Conclusions:

• The long-term risk of recurrent high-grade CIN or cervical cancer after treatment is relatively low.
• Women achieving three consecutive negative cytology results or negative hrHPV co-testing at 6 and 24 months have a low risk comparable to the general population undergoing routine screening.
• These findings support the return of such women to regular, population-based screening schedules.