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Guideline-Concordant Surveillance After Treatment for High-Grade Cervical Dysplasia
Victoria Wang1, Jacquelyn M Lykken, Jasmin A Tiro
1Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, the Department of Obstetrics and Gynecology, Boston Medical Center, the Boston University Chobanian and Avedisian School of Medicine, and the Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Population and Data Sciences and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas; the Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Objective:
To quantify how many patients treated for high-grade cervical dysplasia completed guideline-concordant surveillance.
Methods:
We retrospectively analyzed patients aged 30-65 treated for high-grade cervical dysplasia (cervical intraepithelial neoplasia 2 or worse) at two PROSPR II METRICS (Population-based Research to Optimize the Screening Process Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations sites) (Massachusetts General Brigham, Parkland Health) from 2010 to 2019. The primary outcome was receipt of two negative co-tests after treatment within 30 months (allowing 6-month scheduling leeway).
Results:
Among 3,146 patients treated for high-grade dysplasia, most were aged 30-39 years (Massachusetts General Brigham 58.9%, Parkland Health 60.9%) and had no or few known comorbidities (Massachusetts General Brigham 81.2%, Parkland Health 85.6%). Race and ethnicity, insurance status, and socioeconomic status reflected broader patient population demographics. Only half of the patients (45.5%) completed two surveillance co-tests after treatment within 30 months (Massachusetts General Brigham 55.3%, Parkland Health 40.6%), among whom a third received at least one subsequent abnormal co-test result (Massachusetts General Brigham 30.9%, Parkland Health 31.6%). Patients who completed two co-tests were under observation longer than those who did not complete two co-tests (median Massachusetts General Brigham 64.9 months vs 33.1 months, median Parkland Health 63.9 months vs 41.8 months). Among patients who completed two co-tests, the timing of surveillance co-testing was largely concordant with guidelines (median [interquartile range] time to first co-test: Massachusetts General Brigham 6.4 [5.1-9.2] months, Parkland Health 10.1 [6.6-12.6] months; median [interquartile range] time between first and second co-test: Massachusetts General Brigham 8.5 [6.0-12.6] months, Parkland Health 12.0 [8.0-13.5] months). Overall, 16 patients (0.5%) were diagnosed with cervical cancer after treatment for high-grade dysplasia (median [interquartile range] time from treatment to cancer diagnosis 14.9 [3.8-45.9] months).
Conclusion:
Approximately half of patients did not receive guideline-concordant surveillance after treatment for high-grade dysplasia, and one-third had a subsequent abnormal co-test result. Patients with high-grade cervical dysplasia are at elevated risk of subsequent abnormalities and should continue to be closely monitored. Additional systematic monitoring is needed to ensure guideline-compliant surveillance after dysplasia treatment.
