title: On maintaining the balance.
abstract: Recent studies have shown an association of loop electrocautery excision procedure (LEEP) with subsequent obstetric complications, including preterm birth. These data necessitate a reevaluation of how LEEP is used, particularly in cases where the presence of a high-grade lesion has not been established. In the 2001 consensus guidelines, nonadolescent women with high-grade cytology and subsequent negative colposcopy and endocervical curettage are recommended to undergo LEEP for further evaluation. Given the new information on potential obstetric complications and the rising age of childbearing, it is debatable whether the benefits of LEEP in this situation truly outweigh the risks for all women, regardless of age, who have not completed childbearing. We urge the committee charged with revising the guidelines to carefully consider this issue.
authors.affiliation: Division of Gynecologic Oncology, The Permanente Medical Group, Walnut Creek and Sacramento, CA 94596, USA. betty.suh-burgmann@kp.org
authors.forename: Betty
authors.initials: B
authors.lastname: Suh-Burgmann
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
mesh_terms: D004598:Electrosurgery / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000209:etiology*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000601:surgery*