Women With Cervical Intraepithelial Neoplasia: Requirement for Active Long-Term Surveillance After Therapy

Extract

In this issue of the Journal, Melnikow et al. ( 1 ) present a retrospective long-term follow-up analysis of 37 142 women who were treated for cervical intraepithelial neoplasia (CIN) 1, 2, and 3 from 1986 through 2000 and were under active surveillance after therapy through 2004. These women were compared with a cohort of women with no previous diagnosis of CIN who were under active surveillance.

This retrospective long-term follow-up study demonstrates that our screening methods are not as sensitive as we might hope and that high-grade CIN (ie, CIN 2 or 3 [CIN 2/3]) and/or cervical carcinoma can elude active surveillance methods. Results of this study also support evidence that active surveillance has value in identifying the majority of the high-grade CIN lesions and cervical carcinomas and that the majority of cervical carcinomas can be identified at an early stage. These data also support a recent study ( 2 ) and current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines ( 3 , 4 ) that women with a previous diagnosis of CIN have an increased risk of subsequent high-grade CIN and cervical carcinoma and require continued surveillance and follow-up for 20 years or more.