Monitoring After Treatment of Precancerous Cervical Lesions

Each year in the US, an estimated 200 000 patients1 receive a diagnosis of precancerous cervical lesions caused by human papillomavirus (HPV), the most common of which are cervical intraepithelial neoplasia (CIN) grades 2 (CIN2) and 3 (CIN3), also known as high-grade squamous intraepithelial lesion. Most patients undergo treatment with an excisional procedure (loop excision, cold knife cone biopsy), and some undergo an ablative procedure (cryotherapy, laser, thermal ablation). Because treatments have a 5% to 10% risk of failure (defined as residual high-grade squamous intraepithelial lesion) and about 0.5% of patients receive a diagnosis of cancer during the immediate posttreatment period (2.5 years after treatment), close monitoring after treatment is a critical step in further decreasing cervical cancer morbidity and mortality; such monitoring commonly falls within the purview of primary care clinicians. Unfortunately, only half of patients undergo the posttreatment monitoring recommended by guidelines.

This Clinical Insights article is designed to provide primary care clinicians with a comprehensive overview of monitoring patients after treatment of precancerous cervical lesions, much of which may take place outside of the obstetrics and gynecology setting. We focus on posttreatment monitoring of CIN2 and CIN3, not precancerous lesions of endocervical cells (adenocarcinoma in situ). Our article summarizes guidance provided to frontline clinicians by the American Society for Colposcopy and Cervical Pathology through a comprehensive publication, a free online calculator, and a fee-based application.