Risk Factors for Persistent Cervical Intraepithelial Neoplasia Grades 1 and 2

Abstract

Objective This study examines risk factors for persistent cervical intraepithelial neoplasia (CIN) and whether human papillomavirus (HPV) testing predicts persistent lesions. Materials and Methods Women with histologically diagnosed CIN 1 or CIN 2 (n = 206) were followed every 3 months without treatment. HPV genotyping, plasma levels of ascorbic acid, and red blood cell folate were obtained. Cervical biopsy at 12 months determined the presence of CIN. Relative risk (RR) was estimated by log-linked binomial regression models. Results At 12 months, 70% of CIN 1 versus 54% of CIN 2 lesions spontaneously regressed (p< 0.001). Levels of folate or ascorbic acid were not associated with persistent CIN at 12 months. Compared to HPV negative women, those with multiple HPV types (RRs ranged from 1.68 to 2.17 at each follow-up visit) or high-risk types (RRs range = 1.74 to 2.09) were at increased risk for persistent CIN; women with HPV 16/18 had the highest risk (RRs range = 1.91 to 2.21). Persistent infection with a high-risk type was also associated with persistent CIN (RRs range = 1.50 – 2.35). Typing for high-risk HPVs at 6 months only had a sensitivity of 46% in predicting persistence of any lesions at 12 months. Conclusion Spontaneous regression of CIN 1 and CIN 2 occurs frequently within 12 months. HPV infection is the major risk factor for persistent CIN. However, HPV testing cannot reliably predict persistence of any lesion.

Cervical Precancerous Lesions and Cancer among Patients in the Gynaecology Outpatient Department at a Tertiary Hospital in South Africa

“…A possible explanation for this proportional rate variance among the various Cervical lesions is the fact that some CIN II lesions might regress to CIN I lesions and that some CIN I lesions might regress to normal (Kruger and Botha 2008;Levisohn et al, 2008;Ho et al, 2011). This regression is dependent on the competency of the patient's immune system and also in the case of HIV Reactive patients; the sooner the patient is placed on HAART, the higher the possibility of CIN regression and the reduction in CIN prevalence among HIV Reactive patients (Levisohn et al, 2008;Memiah et al, 2012).…”

Review of the current knowledge on the epidemiology, pathogenesis, and prevention of human papillomavirus infection

“…In another study, women with histologically diagnosed CIN1 or CIN2 were followed up for determination of the risk factors for persistent CIN. Approximately 70% of the women with untreated CIN1 and 54% of women with untreated CIN2 lesions regressed spontaneously within 12 months (Ho et al, 2011).…”

Local cytokine profiles of patients with cervical intraepithelial and invasive neoplasia

“…In studies of patients with low grade cervical intraepithelial lesions (LSILs), the vast majority has spontaneous regression, while a small percentage progress to high grade cervical intraepithelial lesions (HSILs) or invasive cancer (CA) [10]. Given that spontaneous regression of LSIL, as well as other histological types of tumors, is mediated by the immune response, it is of fundamental importance to understand the mechanisms by which the immune system contains or destroys cancer cells.…”