Management of Cervical Intraepithelial Neoplasia 2 in Adolescent and Young Women

Abstract 

Study Objective

To evaluate regression rates among adolescents (aged ≤21) with cervical intraepithelial neoplasia (CIN) 2 managed expectantly and to determine factors associated with disease regression.

Design

Cohort study using a colposcopic database of 2,996 women seen between August 1999 and November 2005.

Setting

Colposcopy clinic in urban, tertiary care medical center.

Participants

Adolescents with CIN 2. Routine management consisted of two options: immediate treatment or repeat colposcopic evaluation in 6 months.

Main Outcome Measures

For those managed conservatively, regression was defined either as a subsequent normal colposcopy and/or biopsy and at least 2 smears read as negative for epithelial abnormality or at least 3 consecutive negative smears if repeat colposcopy was not performed. Demographic information, including age, was assessed to determine possible associations with disease regression.

Results

Of the 93 adolescents, 53 (57%) elected to undergo immediate treatment with a diagnostic excisional procedure, and 40 (43%) chose management with colposcopic follow-up. Of those treated, high-grade disease (CIN 2+) was found in 40 (75%). Of the 36 young women followed conservatively (4 were lost to follow-up), regression after a median follow-up time of 378 days was documented in 14 (39%). Of the 22 adolescents not fulfilling our criteria for regression, only 3 had evidence of CIN 2 or worse during follow-up. The remaining 19 had either CIN 1 or mildly abnormal cytologic results. Kaplan-Meier survival estimates indicated younger age (≤16 years) tended to be associated with decreased time to regression.

Conclusion

Based on significant regression of CIN 2 among adolescent women, primary management in this population should consist of cytologic and colposcopic follow-up.

Key Words: CIN 2, Adolescent, Management