Risks of cervical intraepithelial neoplasia grade 3 or invasive cancers in ASCUS women with different management: a population-based cohort study

Abstract

ObjectiveTo investigate the progression risk of atypical squamous cells of undetermined significance (ASCUS) with different clinical managements.MethodsWomen with their first diagnosis of ASCUS cytology were retrieved from the national cervical cancer screening database and linked to the national health insurance research database to identify the management of these women. The incidences of developing cervical intraepithelial neoplasia grade 3 and invasive cervical cancer (CIN3+) were calculated, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. This study was approved by the Research Ethics Committee of the National Taiwan University Hospital and is registered at ClinicalTrials.gov (Identifier: NCT02063152).ResultsThere were total 69,741 women included. Various management strategies including colposcopy, cervical biopsies and/or endocervical curettage, and cryotherapy, failed to reduce the risk of subsequent CIN3+ compared with repeat cervical smears. Loop electrosurgical excision procedure/conization significantly decreased risk of subsequent CIN3+ lesions (HR=0.22; 95% confidence interval [CI]=0.07–0.68; p=0.010). Women in their 40s–50s had an approximately 30% risk reduction compared to other age groups. Women with a previous screening history >5 years from the present ASCUS diagnosis were at increased risk for CIN3+ (HR=1.24; 95% CI=1.03–1.49; p=0.020).ConclusionIn women of first-time ASCUS cytology, a program of repeat cytology can be an acceptable clinical option in low-resource settings. Caution should be taken especially in women with remote cervical screening history more than 5 years.

Analysis of the related factors of atypical squamous cells of undetermined significance (ASC-US) in cervical cytology of post-menopausal women

“…Tai et al. reported that the incidence of CIN3+ lesions in the women aged over 60 years was higher than that in the women aged between 30 and 60 years ( Tai et al., 2018 ). Similar to other studies, the detection rate of CIN2+ in the post-menopausal women in this study was significantly lower than that in the pre-menopausal patients with ASC-US.…”

“…It has been reported that the detection rate of CIN2+ in women with ASC-US over 50 years of age is much higher than that under 50 years of age ( Wang et al., 2020b ). In one survey, the incidence of CIN3+ lesions was higher in women younger than 30 years and those older than 60 years old ( Tai et al., 2018 ). However, some studies have suggested that there is no difference in the HSIL+ detection rate in women with ASCUS before and after 50 years old ( Abdulaziz et al., 2020 ).…”