Journal
OBSTETRICS AND GYNECOLOGY
Volume 113, Issue 1, Pages 18-25Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AOG.0b013e31818f5008
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Funding
- National Cancer Institute
- National Institutes of Health Department of Health [CN-55153, CN-55154, CN-55155, CN-55156, CN-55157, CN-55158, CN-55159, CN-55105]
- DIVISION OF CANCER PREVENTION AND CONTROL [N01CN055155, N01CN055105, N01CN055153, N01CN055158, N01CN055157, N01CN055154, N01CN055156, N01CN055159] Funding Source: NIH RePORTER
- NATIONAL CANCER INSTITUTE [ZIACP010124] Funding Source: NIH RePORTER
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OBJECTIVE: To estimate the fraction of cervical intraepithelial neoplasia 2 (CIN 2) that might regress if untreated using data from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS). METHODS: We compared the cumulative occurrence of CIN 2 (n=397) and CIN 3 or more severe (n=542) diagnosed by the Pathology Quality Control Group in three trial arms-immediate colposcopy, human papillomavirus (HPV) triage, and conservative management-over the 2-year duration of the ALTS trial. A nonparametric test of trend was used to test for differences in the number of CIN 2 cases relative to number of CIN 3 or more severe cases across study arms with an increasing percentage of women referred to colposcopy at baseline. RESULTS: There were no significant differences in the cumulative 2-year cumulative CIN 3 or more severe diagnoses by study arm (10.9%, conservative management; 10.3%, HPV; 10.9%, immediate colposcopy) (P-trend=.8), but there was a significant increase in CIN 2 diagnoses (5.8%, conservative management; 7.8%, HPV triage; 9.9%, immediate colposcopy) (P-trend<.001) in the study arms, with increasing number of women referred to colposcopy at baseline. The relative differences in cumulative CIN 2 by study arm among women who tested HPV-16 positive at baseline were less pronounced (P-trend=.1) than women who tested positive for other high-risk-HPV genotypes (P-trend=.01). CONCLUSION: There was evidence that approximately 40% of undiagnosed CIN 2 will regress over 2 years, but CIN 2 caused by HPV-16 may be less likely to regress than CIN 2 caused by other high-risk-HPV genotypes.
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