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Objective Recent meta-analyses have shown that loop treatment of the cervix of >10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment.Design Observational cohort study.Setting Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK.Population In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003.Methods Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots.Outcome measures Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with highgrade histology. Any dyskaryotic cytology on follow-up was also documented.Results Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women £35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths <10 mm compared with ‡10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth <10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women >35 years. ConclusionIn women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.

Background:The commencing age of cervical screening in England was raised from 20 to 25 years in 2004. Cervical cancer incidence in young women of England is increasing. It is not clear if this is due to either greater exposure to population risk factors or reduced cervical screening.Methods:We measured if the relative risk of cervical cancer in younger women (20–29 years) of the north-east of England (NE) differed to that of women aged 30yrs and above since 2004. We also measured average annual percentage change (AAPC) in the 3 yr moving average incidence for all age-groups. Regional screening coverage rate and population risk factors were reviewed. Comparisons were made with Wales where screening continues to commence from the age of 20 yrs.Results:Cervical cancer incidence in women aged 20–29 increased annually by an average of 10.3% between 2000 and 2009. The rise in women aged 30–39 was less steep (3.5%/year) but no significant rise was observed in women aged 40–49. Socioeconomic factors remained stable or improved during the time period except for the incidence of chlamydia, herpes simplex and in particular, genital warts, which increased significantly in young women. Data from Wales show similar results.Conclusion:The incidence of cervical cancers in young women of the NE is increasing. The rise in incidence is unrelated to the change in screening policy in 2004. Close monitoring of incidence in young women and a greater attempt to reverse the current decline in screening coverage of women aged 25–29 years are recommended.