Controversies in the management of low-grade cervical intraepithelial neoplasia

During the last 30 years, there have been major changes in the methods used to diagnose and manage cervical cancer precursors. Early detection of precursors through mass cytologic screening programs and the eradication of these precursors when detected are currently the cornerstone of policies aimed at reducing cervical cancer. These policies have been successful, resulting in a marked reduction in both the number of cases and deaths from cervical cancer in North America and Western Europe. Recently, however, significant controversy has arisen over several aspects of the diagnosis and management of cervical intraepithelial neoplasia (CIN). Two of the most important of these controversies are whether all patients with low-grade CIN lesions require therapy and what is the appropriate role for the newly introduced loop electrosurgical excision procedure in managing patients with CIN. In this article, these controversies are reviewed with emphasis placed on how these controversies affect the practicing gynecologist.