Guideline-Concordant Surveillance After Treatment for High-Grade Cervical Dysplasia
OBJECTIVE:
To quantify how many patients treated for high-grade cervical dysplasia completed guideline-concordant surveillance.
METHODS:
We retrospectively analyzed patients aged 30–65 treated for high-grade cervical dysplasia (cervical intraepithelial neoplasia 2 or worse) at two PROSPR II METRICS (Population-based Research to Optimize the Screening Process Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations sites) (Massachusetts General Brigham, Parkland Health) from 2010 to 2019. The primary outcome was receipt of two negative co-tests after treatment within 30 months (allowing 6-month scheduling leeway).
RESULTS:
Among 3,146 patients treated for high-grade dysplasia, most were aged 30–39 years (Massachusetts General Brigham 58.9%, Parkland Health 60.9%) and had no or few known comorbidities (Massachusetts General Brigham 81.2%, Parkland Health 85.6%). Race and ethnicity, insurance status, and socioeconomic status reflected broader patient population demographics. Only half of the patients (45.5%) completed two surveillance co-tests after treatment within 30 months (Massachusetts General Brigham 55.3%, Parkland Health 40.6%), among whom a third received at least one subsequent abnormal co-test result (Massachusetts General Brigham 30.9%, Parkland Health 31.6%). Patients who completed two co-tests were under observation longer than those who did not complete two co-tests (median Massachusetts General Brigham 64.9 months vs 33.1 months, median Parkland Health 63.9 months vs 41.8 months). Among patients who completed two co-tests, the timing of surveillance co-testing was largely concordant with guidelines (median [interquartile range] time to first co-test: Massachusetts General Brigham 6.4 [5.1–9.2] months, Parkland Health 10.1 [6.6–12.6] months; median [interquartile range] time between first and second co-test: Massachusetts General Brigham 8.5 [6.0–12.6] months, Parkland Health 12.0 [8.0–13.5] months). Overall, 16 patients (0.5%) were diagnosed with cervical cancer after treatment for high-grade dysplasia (median [interquartile range] time from treatment to cancer diagnosis 14.9 [3.8–45.9] months).
CONCLUSION:
Approximately half of patients did not receive guideline-concordant surveillance after treatment for high-grade dysplasia, and one-third had a subsequent abnormal co-test result. Patients with high-grade cervical dysplasia are at elevated risk of subsequent abnormalities and should continue to be closely monitored. Additional systematic monitoring is needed to ensure guideline-compliant surveillance after dysplasia treatment.