Treatments that remove abnormal cervical lesions before they can turn into cancer save lives, but they may also lead to complications during pregnancy, a review of the research shows.
Women who had the procedures also had an increased risk for several adverse pregnancy outcomes, including giving birth to preterm or low-birth weight babies and needing C-section.
Researchers who reviewed 27 studies examining the most widely used treatments for removing abnormal cervical cells concluded that they are associated with a “small but real increase” in the risk of pregnancy-related problems.
They further concluded that close surveillance may be a better option than treatment for young women because young women have a very low risk of developing cervical cancer.
“The current vogue (in favor of treatment) has clearly been shown to have long-term adverse obstetric outcomes, and delay in treatment would avoid these unnecessary outcomes in a substantial proportion of women younger than 25 years,” researcher Maria Kyrgiou, MD, and colleagues from London’s Royal Preston Hospital wrote in the Feb. 11 issue of The Lancet.
Concerns About Overtreatment
Cervical cancer deaths in the U.S. have dropped by almost 50 percent since the 1970s, thanks to increased screening using the Pap test.
During a routine Pap smear, cervical cells are sampled and sent to the lab to look for cell changes or abnormalities that might be cancerous or become cancerous.
But there have been increasing concerns that universal testing has resulted in overtreatment of suspicious lesions, especially among very young women who have a low risk of developing cervical cancer.
In 70 to 90 percent of cases, mild cellular abnormalities in young women go away on their own without treatment, American Cancer Society gynecologic cancer expert Debbie Saslow, PhD, tells WebMD.
This is why the ACS has come out against the aggressive treatment of young women with mildly abnormal Pap results, she says.
“Less than one in 100,000 women will get cervical cancer before the age of 25,” she says. “That isn’t zero, but it is a very low risk.”
Knife, Laser, or Loop
The newly published analysis examined obstetric outcomes in women who had abnormal cervical cells removed by either:
Cold-knife conization, in which a scalpel is used to remove a cone-shaped wedge of tissue containing the abnormal cells. Laser ablation, in which the abnormal cells are burned away. Laser conization, which uses a carbon dioxide laser to remove tissue containing the abnormal cells. Large-loop excision of the transformation zone (LLETZ), which involves removing tissue with a low-voltage electrified wire loop. This is also known as loop electrosurgical excision procedure, or LEEP.
The cold-knife procedure was found to be associated with an increased risk of preterm delivery, low birth weight, and C-section, while LLETZ or LEEP increased the risk for preterm delivery, low birth weight, and a pregnant woman’s membranes rupturing (breaking her water) prematurely.
“The outcomes for LLETZ are especially important,” wrote Kyrgiou and colleagues, “because it is now by far the most popular treatment for [removing precancerous cells].”
There were fewer adverse events with the laser conization procedure, and no significant increase in risk was seen with laser ablation.
While the findings seem to favor laser ablation for minimizing obstetric risk, Saslow says the other procedures may have advantages in other areas.
“There are pros and cons with all of these procedures, and a physician may have other reasons for performing one over another,” she says.
By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Kyrgiou, M. The Lancet, Feb. 11, 2006; vol 367: pp 489-498. Maria Kyrgiou, MD, department of obstetrics and gynecology, Queen Charlotte’s and Chelsea Hospital, Hammersmith Hospitals, London. Debbie Saslow, PhD, director of breast and gynecologic cancers, American Cancer Society.