title: Cervical excisional treatment of young women: a population-based study.
abstract: OBJECTIVE
  Assessment of cytology and biopsy results preceding cervical excisional treatment and their association with excisional histology, to evaluate compliance with treatment recommendations and the potential effect of revisions in cervical histology terminology and usage.
  
  
  METHODS
  Data from a unique statewide population-based screening registry was used to describe the use and histologic outcomes of cervical excisional procedures in the year following an abnormal cervical screening cytology.
  
  
  RESULTS
  From 2007 to 2011, LEEP rates decreased 87%, 45%, and 16% for women aged 15-20, 21-24, and 25-29 years, respectively. Reductions were attributable to an overall decline in cervical screening and colposcopy, and a decrease in LEEP following a diagnosis of less than cervical intraepithelial neoplasia grade 2 (<CIN2) or CIN2 histology preceded by any abnormal cytology other than high-grade squamous intraepithelial lesion (<HSIL). LEEP rates did not change significantly (p>0.7) for women aged 30-39 years. Irrespective of age, CIN2 was the most common histologic antecedent of excisional treatment (42%), with most (80%) preceded by <HSIL cytology.
  
  
  CONCLUSIONS
  Cervical excisions are an unavoidable consequence of cervical screening. Adherence to treatment guidelines stipulating conservative follow-up of young women with biopsies ≤CIN2 could significantly decrease the number of excisional procedures and associated harms. This opportunity will be lost if cervical intraepithelial neoplasia grade 3 (CIN3) and some or all of CIN2 are merged into a single histologic category, as has been recently recommended in the United States.
authors.affiliation: Department of Women's Health and Division of Gynecologic Oncology, The Permanente Medical Group, Oakland, CA, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.affiliation: Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Hunt
authors.affiliation: Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Dinkelspiel
authors.affiliation: Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Robertson
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Electronic address: cwheeler@salud.unm.edu.
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data; D019092:Conization / Q000379:methods / Q000706:statistics & numerical data; D004598:Electrosurgery / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009516:New Mexico / Q000453:epidemiology; D012042:Registries; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
keywords: Adherence to cervical treatment guidelines; Cervical intraepithelial neoplasia grades 2 and 3 (CIN2 and CIN3); Cervical screening; Colposcopy; Effectiveness and harms of cervical screening; Loop electrosurgical excision procedure (LEEP)