Laser Conization in the Management of Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma of the Uterine Cervix

Andersen, E.

doi:10.1089/gyn.2000.16.1

Cited by 2 publications

(2 citation statements)

References 129 publications

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“…The estimate for the risk of preterm prelabour rupture of membranes was higher, with a wider confidence interval (pooled RR 3.40, 95% CI 1.63-8.11). 10,13,14,18,20,38 Three studies used standardisation with populationbased data 7,8,27 giving an SPR of preterm birth associated with excisional treatment 2.46 (95% CI 1.96-3.08).…”

Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 99%

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

201

145

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Background Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups.Objectives To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk.Search strategy PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009.Selection criteria Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group.Data collection and analysis Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model.Main results Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used.

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Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 99%

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

201

145

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“…Cold‐knife conizations were gradually replaced by laser conizations and large loop excisions of the transformation zone (LLETZ). The latter quickly became the preferred modality,18 and by the mid‐1990′s, this led to a switch from primarily in‐patient to primarily out‐patient CIN treatment. The first comprehensive evidence‐based national guidelines for CIN treatment were issued in 2001,19 recommending LLETZ for CIN2 and CIN3, and for CIN1 persisting for more than 12 months.…”

Section: Methodsmentioning

confidence: 99%

Frequency of cervical intraepithelial neoplasia treatment in a well‐screened population

Barken

Rebolj

Andersen

et al. 2011

Intl Journal of Cancer

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Treatment of cervical intraepithelial neoplasia (CIN) detectable at screening has helped reduce the incidence of cervical cancer, but has also led to overtreatment. The estimates of overtreatment have often focused on a particular grade of CIN or age group. The aim of this paper was to provide a nationwide population-based estimate of the frequency of CIN treatment per prevented cervical cancer case in a well-screened population. We retrieved the data from the Danish National Population, Patient, Health Insurance, Pathology, and Cancer Registers, and calculated annual age-standardized CIN treatment rates. We estimated the frequency of CIN treatment per prevented cervical cancer case by comparing the cumulative life-time risk of CIN treatment from 1996 onward, with the difference in the cumulative life-time risks of cervical cancer in the prescreening and the screening periods. Since 1996, more than 5,000 CIN treatments were undertaken annually in the population of about 2.2 million women aged 15-84 years, and at present 5.2 CIN treatments are undertaken per 1,000 women aged 20-49. About six women have undergone CIN treatment for each prevented cervical cancer. The frequency of CIN treatment increased after 2004 and at present almost eight women are treated per prevented cervical cancer case. Screening, though effective in reducing the incidence of cervical cancer, leads also to a considerable burden of CIN treatment. Future trends in CIN treatment should be closely monitored.Cervical intraepithelial neoplasia (CIN) can be detected at screening, so that its progression to cervical cancer can be stopped. 1 The burden of cervical cancer has decreased, because the introduction of screening in Europe and Northern America in the 1960's, with data from several long-standing cancer registers showing that the incidence rates in most of these countries have more than halved since then. 2 However, not all untreated CIN would progress to cancer, 3 and there is at present no reliable method to distinguish between progressing and nonprogressing CIN. As a consequence, the reduction in the burden of cervical cancer for some women has been achieved by treating nonprogressive CIN in other women, and CIN treatment may potentially lead to adverse obstetric outcomes. 4,5 Even for highgrade CIN such as CIN3, the proportion without progression to cancer appears to be substantial. For example, following an unethical experiment in New Zealand in 1965-1974, during which women diagnosed with carcinoma in situ were withheld adequate treatment, 31% of those with ''minimum disturbance'' of the lesion developed cervical cancer in the following 30 years. 6 In the currently well-screened women, CIN lesions are probably diagnosed at an earlier stage compared with the New Zealand experiment. Lesions detected earlier may be smaller and have a lower potential for

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Laser Conization in the Management of Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma of the Uterine Cervix

Cited by 2 publications

References 129 publications

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Frequency of cervical intraepithelial neoplasia treatment in a well‐screened population

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