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CIN 2 among women younger than 25 likely to regress

Clinical Question:
Is cervical intraepithelial neoplasia grade 2 in women younger than 25 years likely to regress spontaneously?

Bottom Line:
Cervical intraepithelial neoplasia (CIN) grade 2 frequently regresses in women younger than 25 years. Clinical trials comparing intervention with conservative management are needed. (LOE = 2b-)

Reference:
McAllum B, Sykes PH, Sadler L, Macnab H, Simcock BJ, Mekhail AK. Is the treatment of CIN 2 always necessary in women under 25 years old? Am J Obstet Gynecol 2011;205:478e.1-7.  [PMID:21872201]

Study Design:
Cohort (retrospective)

Funding:
Foundation

Setting:
Outpatient (specialty)

Synopsis:
This was a retrospective cohort study of 452 women from New Zealand with CIN 2 or CIN 2/3. The authors assessed the outcomes of 157 women whose health care providers had decided to offer conservative management; they were not treated within 4 months of the time of diagnosis. The women were followed up for a median of 8 months. The most recent cytologic or histologic results were used to determine whether there was disease progression to cancer; persistence of CIN 2 or 3; or regression to normal, CIN 1, or cells of undetermined significance. No women progressed to cancer, 98 of 157 (62%) showed spontaneous regression, and the remainder had persistent disease. In the immediate treatment group, 2 women had adenocarcinoma in situ and one had squamous cell carcinoma. Important limitations of this study are its lack of histologic determination of outcomes for all women and its relatively short follow-up period. Only 50 women were followed up for 10 months or more. The conservative treatment group might have included women with undiagnosed cancers.

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