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Benefits and Harms of Immediate Versus Delayed Treatment of Cervical Intraepithelial Neoplasia Grade 2 : A Target
Li C Cheung1, Fangya Mao1, Greg Rydzak2
1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland (L.C.C., F.M., N.W.).
Background:
Cervical intraepithelial neoplasia (CIN) grade 2 (CIN 2) is an equivocal diagnosis of cervical precancer, and appropriate management continues to be debated.
Objective:
To estimate the effect of immediate (by 6 months) versus delayed (after 6 months or no) treatment of CIN 2.
Design:
Observational emulation of a target trial of immediate versus delayed treatment, using inverse probability weighting (IPW) to adjust for baseline factors.
Setting:
Routine cervical screening at Kaiser Permanente Northern California.
Patients:
12 012 women with CIN 2 found on initial biopsy from 2017 to 2023.
Intervention:
Immediate treatment (excision by 6 months after initial CIN 2 without interim surveillance by screening or colposcopy) versus delayed treatment (continued surveillance by screening or colposcopy, regardless of subsequent excision timing, or excision ≥6 months after initial CIN 2).
Measurements:
3-year probability of potentially unnecessary excision (less severe than CIN 2 [
Results:
Immediate treatment was associated with a higher 3-year probability of
Limitation:
Lack of randomized assignment to interventions; cancer was rare.
Conclusion:
Immediate treatment did not reduce 3-year cancer risk compared with delayed treatment after CIN 2. Delaying treatment avoided some potentially unnecessary excisions but women with CIN 2 with immediate or delayed care were still at risk for cancer and required monitoring.
Primary Funding Source:
Intramural Research Program of the National Institutes of Health National Cancer Institute.
