Benefits and Harms of Immediate Versus Delayed Treatment of Cervical Intraepithelial Neoplasia Grade 2 : A Target Trial Emulation.

Abstract

Cervical intraepithelial neoplasia (CIN) grade 2 (CIN 2) is an equivocal diagnosis of cervical precancer, and appropriate management continues to be debated. To estimate the effect of immediate (by 6 months) versus delayed (after 6 months or no) treatment of CIN 2. Observational emulation of a target trial of immediate versus delayed treatment, using inverse probability weighting (IPW) to adjust for baseline factors. Routine cervical screening at Kaiser Permanente Northern California. 12 012 women with CIN 2 found on initial biopsy from 2017 to 2023. Immediate treatment (excision by 6 months after initial CIN 2 without interim surveillance by screening or colposcopy) versus delayed treatment (continued surveillance by screening or colposcopy, regardless of subsequent excision timing, or excision ≥6 months after initial CIN 2). 3-year probability of potentially unnecessary excision (less severe than CIN 2 [<CIN 2]), and 3-year risks for CIN grade 3 or more severe (CIN 3+) or invasive cervical cancer after initial CIN 2. Immediate treatment was associated with a higher 3-year probability of <CIN 2 on excision compared with delayed treatment (36.2% vs. 7.8%). The IPW-standardized 3-year risks for cancer (0.39% vs. 0.43%) and CIN 3+ (8.85% vs. 10.31%) were similar under the 2 management strategies. Lack of randomized assignment to interventions; cancer was rare. Immediate treatment did not reduce 3-year cancer risk compared with delayed treatment after CIN 2. Delaying treatment avoided some potentially unnecessary excisions but women with CIN 2 with immediate or delayed care were still at risk for cancer and required monitoring. Intramural Research Program of the National Institutes of Health National Cancer Institute.