LSILs almost always regress in young women

About 91% of low-grade abnormalities on Pap smears in immunocompetent young women regress within 3 years of their finding, and only about 3% progress to high-grade disease, according to a recent cohort study. The findings provide strong support for the position that subjecting all young women with low-grade squamous intraepithelial lesions (LSIL) to colposcopy is unwarranted.

The longitudinal study of human papillomavirus (HPV) infection included females between 13 and 22 years of age. The researchers found that of 187 women with LSIL, 61% regressed by 12 months and 91% regressed by 36 months. They found no associations between regression and HPV status at baseline, sexual behavior, contraceptive use, substance or cigarette use, incident sexually transmitted infection, or biopsy.

While the study was not designed to examine factors that would predict regression, a negative HPV test at a subsequent visit was a good indicator that LSIL regressed. HPV status at the current visit was associated with rate of regression, whether infection was caused by one or more viral types (relative hazard=0.3 and 0.14, respectively). Multiple HPV types had the strongest association with LSIL persistence, a finding that the researchers felt deserved further investigation.

The author of an accompanying editorial agreed, writing that the purpose of screening is to prevent cervical cancer by detecting lesions that will probably become cancerous, and that the psychosexual damage associated with colposcopy in young women outweighs any provided benefit.

Moscicki AB, Shiboski S, Hills NK, et al. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. 2004;364:1678-1683.

Szarewski A, Sasieni P. Cervical screening in adolescents-at least do no harm. Lancet. 2004;364:1642-1643.