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The following is a summary of “Active surveillance of cervical intraepithelial neoplasia grade 2 is not associated with an increased risk of non-cervical anogenital HPV-related cancer and precancer a population-based cohort study,” published in the June 2025 issue of American Journal of Obstetrics & Gynecology by ERIKSEN et al. 

In recent years, many countries have adopted active surveillance for cervical intraepithelial neoplasia grade 2 due to high regression rates and risks linked to excisional treatment.  

Researchers conducted a retrospective study to examine whether women under active surveillance for cervical intraepithelial neoplasia grade 2 had a higher risk of vulvar, vaginal, or anal cancer and precancer compared to those treated with loop electrosurgical excision procedure.  

They implemented a nationwide population-based cohort study in Denmark, including all female residents diagnosed with incident cervical intraepithelial neoplasia grade 2 between ages 18–40 from 1998 to 2020. The primary outcome was vulvar, vaginal, anal cancer, or precancer. Analyses were stratified by age at diagnosis (<30 years, ≥30 years), calendar period (1998–2012, 2013–2020), and index cytology (non-high-grade, high-grade). Secondary outcomes included low-grade lesions of the vulva, vagina, and anus. Cox regression was applied to estimate hazard ratios (HR), with loop electrosurgical excision procedure as the reference. Adjusted HR (aHR) was calculated using inverse probability treatment weighting, accounting for age, calendar year, and index cytology as confounders.  

The results showed that 27,505 women with cervical intraepithelial neoplasia grade 2 were included, with 12,507 (45.5%) managed with active surveillance and 14,998 (54.5%) treated using loop electrosurgical excision procedure. A total of 162 women developed vulvar, vaginal, or anal cancer or precancer. The 10-year cumulative risk was 0.5% (95% CI 0.3–0.6). No significant difference in risk was observed between active surveillance and excisional treatment (aHR = 1.00 [95% CI 0.71–1.40]). Stratified analyses by age, diagnosis year, and index cytology showed similar outcomes. The risk of low-grade vulvar, vaginal, and anal lesions was lower with active surveillance (aHR = 0.75 [95% CI 0.62–0.91]).  

Investigators concluded that active surveillance for cervical intraepithelial neoplasia grade 2 was not linked to an increased risk of non-cervical anogenital cancer or precancer compared to loop electrosurgical excision procedure. 

Source: ajog.org/article/S0002-9378(25)00366-7/fulltext