Before becoming cancerous, lesions of the cervix go through a so-called precancerous stage, during which they are monitored and even treated to prevent their transformation. According to a new study, it would be best to remove them immediately after detection. Explanations from Dr Odile Bagot, gynecologist member of the TipsForWomens expert committee.
Caused in the vast majority of cases by persistent papillomavirus (HPV) infection, cervical cancer affects 3,000 women in Europe each year. Prevention of this cancer lies in vaccination against HPV and smears, to be carried out regularly. It is this examination which allows the detection of precancerous cells, which will be closely monitored to avoid their tumor transformation.
Removing lesions rather than monitoring them
According to a study published in the British Medical Journal end of November 2023, it would be preferable in some cases to remove the lesions immediately after discovering them. To reach this conclusion, scientists brought together the results of a cohort of 27,524 Danish women aged 18 to 40, presenting abnormal lesions, classified CIN2, i.e. considered to be moderately serious, between the years 1998 to 2020.
They were divided into two groups: 12,483 volunteers (45%) benefited from active surveillance after the discovery of their lesions and 15,041 (55%) underwent removal.
Of these volunteers, 104 ultimately developed cervical cancer. For 56 women, the diagnosis was made following active surveillance and for 48 patients, the cancer was discovered in the group chosen to benefit from immediate removal of abnormal cells. “Researchers believe that for grade 2 cancers, removal of lesions is therefore preferable to surveillance.” confirms Dr Odile Bagot, gynecologist and member of the TipsForWomens expert committee.
Increased risk for the group under surveillance
During the first two years of surveillance, the risk of cervical cancer was comparable in the two groups. Then it increases over time, in the group under surveillance. “After 20 years, the risk was even around four times higher in the active surveillance group, while it remained stable in the other group. note the scientists. (Editor’s note: 2.65% versus 0.76%).
How to explain it? Higher long-term risk of cervical cancer in women under active surveillance may be linked to untreated lesion and underlying human papillomavirus infection, experts say in the event of regression. The infection therefore persists, quietly, detectably or not, even in the absence of visible lesions on colposcopy.
Easier interventions these days
Dr Odile Bagot confirms the relevance of the study, providing a caveat. “It is still necessary to make a nuance regarding the type of surveillance carried out: is it only by smear? By colposcopy? Before adding: “At present, treatments, even in young women, do not cause many problems at the cervix, whether for fertility or for childbirth later. This is why we intervene more readily today than in the past.” A trend whose benefits are therefore confirmed by this study.