Do cervical precancerous lesions need immediate treatment?

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For moderate cervical lesions-abnormal cells on the surface of the cervix (commonly called cervical intraepithelial neoplasia grade 2 or CIN2), routine monitoring (“active monitoring”) rather than immediate treatment is recognized. The findings should help women and doctors make more informed choices.

CIN is divided into grade 1, 2 or 3 according to the severity of precancerous lesions, but CIN is not cervical cancer. It may progress to cancer, but it may return to normal (degenerate) or remain unchanged. The diagnosis of CIN2 is currently the entry point for treatment. However, some studies have shown that CIN2 lesions usually resolve completely without treatment and should be actively monitored, especially young women, because treatment may be harmful to future pregnancy.

The study analyzed the results of 36 studies involving 3,160 women diagnosed with CIN2 who had been actively monitored for at least three months. Two years later, 50% of the lesions resolved spontaneously, 32% persisted, and only 18% progressed to CIN3 or worse. Among women under the age of 30, the rate of degradation was higher (60%), 23% maintained, and 11% progressed.

Most CIN2 lesions, especially women younger than 30 years of age, will spontaneously degenerate, so active monitoring rather than immediate intervention is reasonable, especially for young women who may insist on monitoring. The chance of degradation is 50-60%, even if the risk of cancer is small (0.5% in this study), it is still possible. Surveillance only delays treatment, and some people still do not accept it. Other factors should also be considered including the effectiveness of treatment, the inconvenience of regular visits and the possibility of pregnancy complications.

The degradation rate of CIN2 is reassuring, but the degradation rate of CIN2 must be presented in a meaningful way and provide clear information about the effectiveness of monitoring and treatment so that women can make fully informed choices.

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