ArticlesRegression of low-grade squamous intra-epithelial lesions in young women
Introduction
Although human papillomavirus (HPV) infections are strongly linked to the development of cervical cancer, genital HPV infections are common in adolescent and young women, occurring in up to 70% of those who are sexually active.1 More than 70% of HPV infections are transient.1, 2, 3 A cytological manifestation of HPV, low-grade squamous intra-epithelial lesions (LSIL), is also quite common in women; about 25% of adolescent and young women develop LSIL after an HPV infection.4 Although LSIL is thought to be a benign expression of HPV infection, risk factors for of development of LSIL seem to be distinct from those associated with acquiring HPV, which suggests that LSIL development is not a simple HPV infection.4 Additionally, findings of observational studies in adult women have shown that about 20–40% of these lesions will progress to high-grade squamous intra-epithelial lesions (HSIL)—with only 50–60% spontaneously regressing.5, 6, 7
Most natural history studies of LSIL, however, have focused on women in their mid-20s to 40s who might represent a population with HPV infections that are already persistent.5, 6, 7, 8, 9, 10 We postulate that the rate of LSIL regression in adolescent and young women could be much higher than that reported for older women. The objective of this study was to define the probability of LSIL regression in adolescent and young women, and to examine the factors associated with this regression.
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Participants
Women included in this analysis were part of a 10-year natural history study of HPV infection, which was initiated in 1990. The cohort population and study design have been described in detail elsewhere.1 In brief, women aged 13–22 years who attended one of two family planning clinics between 1990 and 1994 were screened for cervical HPV DNA with a commercial test (HPV Profile, Digene Diagnostics, Silver Spring, MD, USA). Those who tested positive and were eligible—ie, with no previous history
Results
899 women in our study of the natural history of HPV infection had valid cytology results; of these, 260 were diagnosed with LSIL by cytology at baseline or at a subsequent visit. 17 women were removed from the study because they had HSIL on histology, six left during the first year of the study because the protocol during 1990–91 called for women with histologically confirmed LSIL to be removed from the study for treatment (this protocol was amended to allow follow-up in 1991), 24 dropped out
Discussion
Our findings suggest that strategy of colposcopy for all adolescent and young women with LSIL is unwarranted and leads to unnecessary intervention, morbidity, and cost. Instead, assessment with serial cytology might be appropriate. In our study, LSIL spontaneously regressed in most women by 3 years of follow-up, showing the benign nature of this condition in adolescent and young women. This high rate of regression and low rate of progression is in accord with overall low rates of HSIL diagnosed
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