Conservative Management of CIN2 Within Primary HPV Cervical Cancer Screening Programme: A Cohort Study

Objectives:

To quantify the probabilities of becoming HPV-negative, or receiving delayed treatment within 24 months in women with CIN2 managed conservatively; describing the determinants of the decision for conservative management, losses to follow-up and outcomes.

Methods:

This prospective cohort included biopsy-confirmed CIN2 from HPV-based pilot screening in Valcamonica, Italy. Women aged 45 and under, with no glandular lesion, and assessed as low-risk by gynecologists were offered conservative management instead of treatment; those who accepted were followed with HPV testing, cytology, and colposcopy at 6, 12, and 24 months; then, if the lesion persisted, treatment was recommended; a few women without inclusion criteria entered the conservative management protocol.

Competing-risk models were built to investigate the determinants of testing negative and log-binomial models for the determinants of decision for conservative management and loss to follow-up.

Results:

In all, 180 out of 352 women with CIN2 choose conservative management. Within 24 months, 25 women were lost to follow-up. Of the remaining, 40.6% (95% CI: 32.8%-48.8%) tested HPV-negative, 43.9% (95% CI: 35.9%-52.1%) underwent delayed treatment, and 15.5% (95% CI: 10.2%-22.2%) remained HPV-positive. Younger age, immediate colposcopy referral, low-grade cytological and grade I colposcopy were associated with the conservative management decision. Women who had attended prior screening testing HPV-negative were more likely to become HPV-negative [SHR 1.93 (95% CI: 1.06-3.49)] and had better adherence to follow-up tests. Two cases of invasive carcinoma were identified in treated women.

Conclusions:

After 24 months, 40% of the women avoided treatment. Women diagnosed at the second HPV screening round are more suitable candidates for conservative management.