Invasive Cancer Following Conservative Therapy for Previous Cervical Intraepithelial Neoplasia

Abstract

From January 1983 to December 1984, 205 cases of invasive cervical cancer were seen in the Gynecologic Oncology Clinic at the Royal Brisbane Hospital. Eleven of these women had been previously treated for cervical intraepithelial neoplasia (CIN); 7 by cone biopsy and 4 by electrocoagulation diathermy. Failure to adhere to the recommended triage protocol emerged as the major factor in allowing malignant progression. Common errors included the use of blind biopsies, reliance on a single biopsy, concurrent therapy at the time of diagnosis, and the use of conservative therapy despite positive endocervical curettage or colposcopically suspect atypical vessels. Finally, 4 of 7 women who developed invasive cancer after an interval of more than 2 years had been lost to follow-up. Colposcopic triage of abnormal Papanicolaou smears is increasingly undertaken by gynecologists with only modest colposcopic experience. Leaders in this area must stress the need for strict adherence to protocol, lest more women die of cervical cancer through errors of diagnosis, treatment or follow-up.