title: Risk factors for persistent cervical intraepithelial neoplasia grades 1 and 2: managed by watchful waiting.
abstract: OBJECTIVE
  : This study examines risk factors for persistent cervical intraepithelial neoplasia (CIN) and examines whether human papillomavirus (HPV) testing predicts persistent lesions.
  
  
  METHODS
  : Women with histologically diagnosed CIN 1 or CIN 2 (n = 206) were followed up every 3 months without treatment. Human papillomavirus genotyping, plasma levels of ascorbic acid, and red blood cell folate levels were obtained. Cervical biopsy at 12 months determined the presence of CIN. Relative risk (RR) was estimated by log-linked binomial regression models.
  
  
  RESULTS
  : At 12 months, 70% of CIN 1 versus 54% of CIN 2 lesions spontaneously regressed (p < .001). Levels of folate or ascorbic acid were not associated with persistent CIN at 12 months. Compared with HPV-negative women, those with multiple HPV types (RRs ranged from 1.68 to 2.17 at each follow-up visit) or high-risk types (RRs range = 1.74-2.09) were at increased risk for persistent CIN; women with HPV-16/18 had the highest risk (RRs range = 1.91-2.21). Persistent infection with a high-risk type was also associated with persistent CIN (RRs range = 1.50-2.35). Typing for high-risk HPVs at 6 months only had a sensitivity of 46% in predicting persistence of any lesions at 12 months.
  
  
  CONCLUSIONS
  : Spontaneous regression of CIN 1 and 2 occurs frequently within 12 months. Human papillomavirus infection is the major risk factor for persistent CIN. However, HPV testing cannot reliably predict persistence of any lesion.
authors.affiliation: Departments of Epidemiology & Population Health, Albert Einstein College of Medicine, NY, USA. gloria.ho@einstein.yu.edu
authors.forename: Gloria Y F
authors.initials: GY
authors.lastname: Ho
authors.forename: Mark H
authors.initials: MH
authors.lastname: Einstein
authors.forename: Seymour L
authors.initials: SL
authors.lastname: Romney
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kadish
authors.forename: Maria
authors.initials: M
authors.lastname: Abadi
authors.forename: Magdy
authors.initials: M
authors.lastname: Mikhail
authors.forename: Jayasri
authors.initials: J
authors.lastname: Basu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Thysen
authors.forename: Laura
authors.initials: L
authors.lastname: Reimers
authors.forename: Prabhudas R
authors.initials: PR
authors.lastname: Palan
authors.forename: Shelly
authors.initials: S
authors.lastname: Trim
authors.forename: Nafisseh
authors.initials: N
authors.lastname: Soroudi
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
mesh_terms: D000328:Adult; D001205:Ascorbic Acid / Q000097:blood; D001706:Biopsy; D005260:Female; D005492:Folic Acid / Q000097:blood; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology*; D012307:Risk Factors; D012720:Severity of Illness Index; D057832:Watchful Waiting / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology
chemical_list: D005492:Folic Acid; D001205:Ascorbic Acid