Invasive Potentiality of Cervical Carcinoma in Situ

Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3

“…The clinical study was started in 1965 11 (before the 1966 approval), but not all women with a diagnosis of CIN3 were included. Some women with persistent or recurrent abnormalities after initial cone biopsy or hysterectomy were also included in the study, 11 and some with microinvasive carcinoma of the cervix, 11 or with vaginal 11 or vulval 7 intraepithelial neoplasia, were followed without treatment. Informed consent was not sought from the women 12…”

“…Although Dr Green claimed his clinical study confirmed that CIN3 rarely progresses to invasive cancer, 11,13–15 McIndoe et al. published in 1984 an independent analysis of outcomes in women diagnosed with CIN3 at National Women’s Hospital in 1955–1976, which demonstrated a 25‐fold increased risk of cervical or vaginal vault cancer in those women with persistent cytological abnormalities, compared with women whose cytology during follow‐up was normal 8 …”

Outcomes for women without conventional treatment for stage 1A (microinvasive) carcinoma of the cervix

“…During the study period, women received varied management. Some surgical procedures were intended to cure (hysterectomy or cone biopsy), while others were not (wedge biopsy or ring biopsy (defined as removal of a shallow cone <2 cm, or <1.5 cm deep)). We classified each procedure according to the likelihood that the treatment was curative based on the procedure used to remove the lesion, whether or not the margins were clear of CIN3, and whether or not there was cytological evidence of persisting disease in the 6–24 months after excision.…”

Science friction: cervical cancer and the contesting of medical beliefs

“…An editorial in a 1967 edition of the New Zealand Medical Journal, for example, noted that it was possible that only a small proportion of the pre-invasive lesions revealed by cytology went on to invasion (NZMJ 1967:886). Uncertainties were also expressed about a link between pre-invasive lesions of the cervix and cervical cancer by Herbert Green (1966Green ( , 1969. Concerns were also expressed about positive smears sometimes being responded to in too radical a way with treatments such as hysterectomy, and there were doctors who advocated a more conservative approach to cytological abnormalities (Baeyertz 1965, NZMJ 1967.…”

“…He claimed that linking cervical screening with a declining incidence of invasive cervical cancer was an example of this tendency. He argued that a decline in mortality rates had begun years before the advent of cervical cytology (Green 1969). Population-based cervical screening was also considered by Green and others who supported his views as being beset by contradictions and irrationalities:…”