Clinical management and risk reduction in women with low-grade squamous intraepithelial lesion cytology: A population-based cohort study
Journal
PLoS ONE
Journal Volume
12
Journal Issue
12
Pages
e0188203
Date Issued
2017
Author(s)
Chen Y.-Y.
You S.-L.
Chen H.-C.
Taiwan Cervical Cancer Control Task Force
Abstract
We analyzed the management and risk of subsequent cervical intraepithelial neoplasm 3 (CIN3) and invasive cervical cancer in women with low-grade squamous intraepithelial lesion (LSIL) cytology. A total of 53,293 women with a new diagnosis of cytologic LSIL were identified in Taiwan’s national cervical screening registration database. Based on the retrieved clinical management data, the incidence of subsequent CIN3+ lesions was determined, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. The average follow-up was 5.02 years. A total of 988 women developed CIN3+ lesions during this period, with an overall incidence of 369.3 women per 100,000 person-years. Cryotherapy and conization/loop electrosurgical excision procedure (LEEP) decreased the subsequent risk of CIN3+ lesions in women younger than 50 years (HR 0.49, 95% confidence interval [CI] 0.37–0.64, p<0.0001 for cryotherapy; HR 0.39, 95% CI 0.27–0.55, p<0.0001 for LEEP). Cryotherapy and conization/LEEP were two significant protective factors for developing CIN3+ lesions, especially in women with biopsy-proven CIN1 (HR 0.55, 95% CI 0.37–0.82, p = 0.003 for cryotherapy; HR 0.43, 95% CI 0.24–0.77, p = 0.005 for LEEP). These results suggest that when women are first screened LSIL and lack prior abnormal cervical cytology, cryotherapy should be one of the treatment options. Younger women with a histological biopsy diagnosis of CIN1 were most likely to benefit from cryotherapy. ? 2017 Tai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Other Subjects
adult; aged; Article; cancer grading; cancer incidence; cancer screening; cohort analysis; colposcopy; controlled study; cryotherapy; cytology; excision; female; human; major clinical study; multivariate analysis; risk factor; risk reduction; squamous intraepithelial lesion of the cervix; Taiwan; tumor invasion; uterine cervix biopsy; uterine cervix cancer; uterine cervix conization; uterine cervix cytology; disease management; health survey; middle aged; pathology; proportional hazards model; risk reduction; squamous intraepithelial lesion of the cervix; Adult; Aged; Disease Management; Female; Humans; Middle Aged; Multivariate Analysis; Population Surveillance; Proportional Hazards Models; Risk Reduction Behavior; Squamous Intraepithelial Lesions of the Cervix
Publisher
Public Library of Science
Type
journal article