Conservative management of CIN2: National Audit of British Society for Colposcopy and Cervical Pathology members’ opinion
| Autor: | Madeleine C. Macdonald, J. E. Palmer, John Tidy, John H F Smith |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Attitude of Health Personnel Population Uterine Cervical Neoplasms Cervix Uteri Disease Conservative Treatment Cervical intraepithelial neoplasia Immunocompromised Host 03 medical and health sciences 0302 clinical medicine medicine Humans education Colposcopy Response rate (survey) Cervical cancer Human papillomavirus 16 education.field_of_study 030219 obstetrics & reproductive medicine Cervical screening Human papillomavirus 18 medicine.diagnostic_test business.industry Smoking Obstetrics and Gynecology Uterine Cervical Dysplasia medicine.disease United Kingdom female genital diseases and pregnancy complications Natural history Health Care Surveys 030220 oncology & carcinogenesis Family medicine Practice Guidelines as Topic Female business |
| Zdroj: | Journal of Obstetrics and Gynaecology. 38:388-394 |
| ISSN: | 1364-6893 0144-3615 |
| DOI: | 10.1080/01443615.2017.1316973 |
| Popis: | There is no doubt that organised cervical screening programmes have significantly reduced the rates of cervical cancer by detection and treatment of high-grade cervical intraepithelial neoplasia (CIN2, CIN3). National UK guidelines do not differentiate between CIN2 and CIN3 as separate entities and recommend treatment for both, although a degree of uncertainty exists regarding the natural history of CIN2. This national survey of British Society for Colposcopy and Cervical Pathology members aimed to assess attitudes towards conservative management (CM) of CIN2 in the UK and identify potential selection criteria. In total, 511 members responded (response rate 32%); 55.6% offered CM for selective cases; 12.4% for all cases; 16.4% had formal guidelines. Most agreed age group was >40yrs (83%), HPV 16/18 positive (51.4%), smoking (60%), immuno-compromise (74.2%), and large lesion size (80.8%) were relative contraindications for CM. 75.9% favoured six-monthly monitoring, with 80.2% preferring excisional treatment for persistent high-grade disease. Many UK colposcopists manage CIN2 conservatively without formal guidelines. Potential selection criteria should be investigated by a multicentre study. Impact statement Although anecdotally some colposcopists manage many women with CIN2 conservatively, this National Audit of British Society for Colposcopy and Cytopathology members, we believe, is the first time this has been formally recorded. The survey assesses current attitudes towards conservative management (CM) of CIN2 and seeks to identify potential selection criteria that could be used to identify suitable women. It received over 500 responses and significantly, identified many colposcopists recommending CM of CIN2 for patients despite the lack of any formal guidance regarding this approach. The greater majority of respondents were keen to consider participating in a multicentre trial on CM of CIN2 targeting the UK screening population (25-64 years). The paper has international relevance as ACOG and ASCCP have recently changed their guidance for the management of CIN2 in younger women and now recommend CM with monitoring rather than first line ablative or excisional treatment due to concerns regarding overtreatment, especially in women who have not yet completed their family. |
| Databáze: | OpenAIRE |
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