CIN 2/3 in Young Women

Last Modified: February 28, 2010

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Question

Dear OncoLink "Ask The Experts,"

I am 23 years old and I recenty had my first abnormal pap smear. The cytology showed HSIL and I had a colposcopy done which showed CIN 2 in a background of CIN 1 with no endocervical involvement. I have received conflicting opinions regarding whether a LEEP is necessary or whether given my age I can wait and have a repeat PAP smear in 4-6 months. I was wondering if there is any evidence to support deferring a LEEP in young women. Thanks for your help.

Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

The Americal Society for Colposcopy and Cervical Pathology (ASCCP) Concensus Guidelines clearly state that women over the age of 21 with CIN2 or CIN3 on cervical biopsy should undergo excision (LEEP or cone biopsy) or ablation of the transformation zone (laser ablation or cryotherapy) if the examination is adequate. However, depending on the appearance of the abnormal spots and the reliability of the patient to adhere to follow up requirements, some practitioners may follow young patients with CIN2 lesions with pap and colposcopy in 4 to 6 months if the endocervical currettage is negative. While percentages vary widely, about 5-10% of CIN2 may progress to invasive cancer, but up to 40% or so may regress. Close follow up in carefully selected patients may be an option.



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