What treatments are available for pre-malignant conditions of the cervix?

It is unclear whether treatments for cervical intraepithelial neoplasia (CIN) increase the subsequent risk of preterm delivery. Most studies have lacked sufficient sample size, mixed heterogeneous subtypes of preterm delivery, and failed to control for confounding factors.

Objectives:

To determine whether cervical laser and loop electrosurgical excision procedure (LEEP) treatments increase risk of preterm delivery and its subtypes. DESIGN, SETTING, AND

Participants:

Retrospective cohort study conducted among women evaluated at a colposcopy clinic serving Auckland, New Zealand (1988-2000), comparing delivery outcomes of untreated women (n = 426) and those treated (n = 652) with laser conization, laser ablation, or LEEP. Record linkage using unique health identifiers identified women who had subsequent deliveries.

Settings, Design and Main Outcome Measures:

Total preterm delivery and its subtypes, spontaneous labor and premature rupture of membranes before 37 weeks' gestation (pPROM).

Results:

The overall rate of preterm delivery was 13.8%. The rate of pPROM was 6.2% and the rate of spontaneous preterm delivery was 3.8%. Analyses showed no significant increase in risk of total preterm delivery (adjusted relative risk [aRR], 1.1; 95% confidence interval [CI], 0.8-1.5) or spontaneous preterm delivery (aRR, 1.3; 95% CI, 0.7-2.6) for any treatment. Risk of pPROM was significantly increased following treatment with laser conization (aRR, 2.7; 95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation (aRR, 1.1; 95% CI, 0.5-2.4). Moreover, risk of pPROM and total preterm delivery increased significantly with increasing height of tissue removed from the cervix in conization. Women in the highest tertile of cone height (> or =1.7 cm) had a greater than 3-fold increase in risk of pPROM compared with untreated women (aRR, 3.6; 95% CI, 1.8-7.5).

Conclusions:

LEEP and laser cone treatments were associated with significantly increased risk of pPROM. Careful consideration should be given to treatment of CIN in women of reproductive age, especially when treatment might reasonably be delayed or targeted to high-risk cases.

Please click on the required question.

• 1 What is the cervix?
• 2 What is a cervical polyp?
• 3 What is meant by cervical erosion (ectopy) and cervicitis?
• 4  What is the transformation zone?
• 5 What is a 'Paptest' (PAP test (cervical smear) test)
• 6  My PAP smear test (cervical smear) shows inflammation. Should I be worried?
• 7  What are cells and what is an abnormal (pre- malignant) cell?
• 8 My PAP smear test (cervical smear) shows abnormal cells. Does this mean that I have cancer?
• 9  What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?
• 10  What are the symptoms of pre-malignancy of the cervix?
• 11  What are benign and malignant tumours?
• 12  Why have I developed a pre-malignant condition of my cervix?
• 13  What is colposcopy?
• 14  What treatments are available for pre-malignant conditions of the cervix?
• 15  Can pre-malignant conditions of the cervix be cured?
• 16  How can I be re-assured that the pre-malignant changes will not recur?
• 17  How can we prevent carcinoma of the cervix?
• 18  Is there a reason to screen for HPV?
• 19  Support Groups.
• 20  Are there any support groups?

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.