Caution urged in some cervical cancer cases

Auckland University researchers say some women of child-bearing age who are known to have low-grade pre-cancerous changes in their cervix should not be treated.

Instead, they should be monitored and "managed conservatively" to avoid problems in later pregnancies.

An American-funded study of National Women's Hospital patients in the wake of the notorious "unfortunate experiment" - disclosed in the 1988 Cartwright Report to have left untreated some women in early stages of cervical cancer - has shown benefits for "conservative" management of some cases.

"We found that women who had the most extensive cervical biopsies were at the greatest risk in pregnancy," lead researcher in the latest study, Dr Lynn Sadler said. "Pre-cancerous changes are more common in women in their reproductive years than in older women, so any effects of treatment on adverse pregnancy outcomes are of major public health concern".

Women in their reproductive years who have been shown with biopsies to have low-grade pre-cancerous cervical changes - known as cervical dysplasia - should be managed conservatively to avoid premature births for later babies.

Significant numbers of women treated for cervical dysplasia later had their waters break early, triggering pre-term births, which has implications for child health.

"We're not saying that young women shouldn't be treated for cervical dysplasia," Dr Sadler said. But the cervical abnormalities should be confirmed by biopsy before treatment, and "high-grade" pre-cancerous changes should always be treated to prevent cervical cancer.

Women with less serious cases should not be treated if they were likely to later give birth.

"Young women with low-grade disease, with low risk of progression to cervical cancer, should be monitored regularly and treated only if the condition progresses," Dr Sadler, a research fellow at Auckland University's faculty of medical and health sciences, said.

"Most of these cases will spontaneously regress back to normal without therapy.

"This approach will likely reduce the risk of subsequent premature delivery".

The research, published this week in the Journal of the American Medical Association, is the first major study of pre-cancerous cervical disease at National Women's since the Cartwright Report, which was told that over 20 years from the mid-1960s some women with the most serious precursor, CIS, were left untreated to test a theory that they would not actually develop invasive cancers.

The latest study involved 652 treated and 426 untreated women visiting the colposcopy clinic at National Women's Hospital from 1988 to 2000.

- NZPA