Conservative Management of CIN2 Within Primary HPV Cervical Cancer Screening Programme: A Cohort Study

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Cervical intraepithelial neoplasia grade 2 (CIN2) management involves treatment or conservative approaches.
• Conservative management decisions are influenced by patient factors and clinical assessments.
• Understanding outcomes of conservative management is crucial for optimizing patient care.

Purpose of the Study:

• To quantify the probability of becoming HPV-negative or requiring delayed treatment within 24 months for CIN2 managed conservatively.
• To identify determinants influencing the choice of conservative management, loss to follow-up, and patient outcomes.

Main Methods:

• Prospective cohort study of women with biopsy-confirmed CIN2.
• Conservative management offered to women aged 45 and under, assessed as low-risk, and without glandular lesions.
• Follow-up included HPV testing, cytology, and colposcopy at 6, 12, and 24 months.
• Competing-risk and log-binomial models were used to analyze determinants.

Main Results:

• 180 out of 352 women chose conservative management.
• Within 24 months, 40.6% became HPV-negative, 43.9% received delayed treatment, and 15.5% remained HPV-positive.
• Younger age, immediate colposcopy, low-grade cytology, and Grade I colposcopy favored conservative management.
• Prior HPV-negative screening was associated with becoming HPV-negative and better follow-up adherence.

Conclusions:

• Conservative management allowed approximately 40% of women with CIN2 to avoid immediate treatment within 24 months.
• Women diagnosed during the second HPV screening round are better candidates for conservative management.
• Two cases of invasive carcinoma were detected in the treated group.