Abnormal smear ‘shouldn’t always mean surgery’

THOUSANDS of women with abnormal cervical smear test results could be monitored instead of going through invasive surgery, a study suggests.

Research involving more than 3,000 women with precancerous changes found that half of cases defined as moderately severe returned to normal within two years without treatment.

Just 18 per cent progressed, with 0.5 per cent becoming cancer, within the time frame. Among women below the age of 30, the rate of regression was even higher, with just 11 per cent of cases progressing.

Researchers from Imperial College London said the findings published in The BMJ suggested many more women should be offered “active surveillance” rather than immediate operations to excise tissue, which are invasive, and can harm future pregnancies.

Abnormal cells on the surface of the cervix are called cervical intra-epithelial neoplasia (CIN) and graded 1, 2 or 3, based on severity. Researchers, led by Maria Kyrgiou, analysed results from 36 studies involving 3,160 women with a laboratory confirmed diagnosis of CIN2, who were actively monitored for at least three months.

Dr Kyrgiou said: “Most CIN2 lesions, particularly in women aged less than 30, regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.”

However, experts said differences between the studies and possible misclassification of some lesions meant the findings “should be interpreted with caution”.

Prof Maggie Cruickshank at the University of Aberdeen, said women should be given an informed choice. In a linked editorial, she wrote: “Knowing that the chance of regression is 50 to 60 per cent, still means taking a gamble that surveillance is simply delaying treatment. Even a small risk of cancer may still be unacceptable to some.”