Erin T. Welsh, MA , 2025-05-17 21:20:00
Key takeaways:
- Only 45.5% of women treated for high-grade cervical dysplasia completed two surveillance co-tests within 30 months.
- Of those who completed co-tests, 0.5% were diagnosed with cervical cancer.
MINNEAPOLIS — Fewer than half of women treated for high-grade cervical dysplasia subsequently received guidance-concordant surveillance, of whom one-third had an abnormal co-test result, researchers reported.
“With the availability of HPV vaccination, cervical cancer remains fully preventable in the U.S. We understand precancer cervical dysplasia to progress along a spectrum and, if left untreated, CIN 2/3 or HSIL possesses the highest risk of progression to cervical carcinoma, with rates predicted from 30% to 50% over 20 years,” Victoria Wang, MD, clinical fellow in obstetrics, gynecology and reproductive biology at Brigham and Women’s Hospital and Harvard University, said during a presentation at the ACOG Annual Clinical & Scientific Meeting. “Fortunately, treatment of HSIL with some kind of decisional procedure, either with loop electrosurgical excision procedure or cold knife cone biopsy, does resolve dysplasia in 70% to 90% of cases. Although, the risk of recurrence in these patients remain high and, therefore, per guidelines, these patients should not go back to population-level screening guidelines.”
Fewer than half of women treated for high-grade cervical dysplasia subsequently received guidance-concordant surveillance, researchers reported.
Wang and colleagues conducted a retrospective study of 3,146 women aged 30 to 65 years who were treated for high-grade cervical dysplasia at Massachusetts General Brigham or Parkland Health. The primary outcome was receipt of two negative co-tests 30 months after treatment. Most women were aged 30 to 39 years and had no or few comorbidities.
Overall, 45.5% of the women completed two surveillance co-tests within 30 months of treatment, with 55.3% from Massachusetts General Brigham and 40.6% from Parkland Health. Of these women, one-third received at least one subsequent abnormal co-test result.
Of the women who completed two surveillance co-tests, the timing of testing was largely concordant with current guidelines, with a median time to first co-test being 6.4 months at Massachusetts General Brigham and 10.1 months at Parkland Health, and a median time between first and second co-test being 8.5 and 12 months, respectively.
In total, 0.5% of women were diagnosed with cervical cancer after being treated for high-grade cervical dysplasia, with a median time of 14.9 months from treatment to diagnosis.
“Overall, the low surveillance rate seemed reflective of challenges that we all know about regarding follow up. We also want to acknowledge that this time period is when the guidelines were changing, so potentially there was some confusion over what the guidelines should be at this time,” Wang said. “While we were unable to differentiate the loss of follow up versus patient movement to other clinical centers in this study … data from state registries and our integrated health care systems leads us to believe that these are pretty real rates of cervical cancer that we’re seeing.”
Reference:
Perspective
Loop electrosurgical excision procedures have been around for 20 to 30 years. It’s a popular treatment, and it has a very high cure rate — about 90%. But if precancerous changes occur after a loop electrosurgical excision procedure, it’s going to happen in the first few years after initial treatment. That’s why there’s a recommendation to do extra testing. We have to get people in for those two visits within those 2 years, because that’s when we’re going to find problems.
I was surprised the uptake wasn’t a little higher in this study, and that’s concerning. We don’t want to miss those people. The authors didn’t really talk about this, but those same patients are at risk for anal cancer, vulvar cancer and more. You don’t want to lose them to follow up, and the follow up is not that complicated. It’s just Pap smears and the HPV test that most OB/GYNs do every day. The authors are well-known experts on the topic in very good OB/GYN departments, so if they’re having trouble doing it, what about the rest of us? We may have even more trouble.
There’s a 90% cure rate, but the only way we’re going to find that 10% is for patients to come to follow up. It’s the classic half-full, half-empty argument, because the cure rate is very high from the procedure, but it’s not zero.
The other thing that the authors didn’t really talk about, which may make the situation worse, is that their timeframe probably didn’t see a lot of reduction because of the HPV vaccine. Now, the data would say we’re going to have fewer people with precancerous cervical cancer, so not as many people in care. Because it is rarer, we may miss people who need extra follow up because we won’t be as familiar with the disease.
There’s a lot of literature — mostly for Pap smears, not so much for follow up — about ways to get people into screening. There is call and recall, where you send patients a notice that they have an appointment coming up in 6 months for a Pap smear to follow up from a loop electrosurgical excision procedure, and offering them the option to reschedule. That strategy alone doesn’t overcome all of the socioeconomic barriers. You have to meet people where they are, as far as outreach. If they want to follow up in their own neighborhood, you would have to point them to the community health center or federally funded center to get it done there. That requires a lot of communication and coordination, so all those solutions are potentially challenging.
Kevin A. Ault, MD
Professor, division of obstetrics and gynecology
Western Michigan University Homer Stryker M.D. School of Medicine
Disclosures: Ault reports no relevant financial disclosures.
Sources/Disclosures
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Wang V, et al. Guideline-concordant surveillance after treatment for high-grade cervical dysplasia. Presented at: ACOG Annual Clinical & Scientific Meeting; May 16-18, 2025; Minneapolis.
Disclosures:
Wang reports no relevant financial disclosures.
