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Surveillance after high-grade cervical dysplasia treatment was low for even two tests, making adherence with the newly recommended three tests even less likely.

Among the less than half of patients who received guideline-concordant surveillance after treatment for high-grade cervical dysplasia at 2 large US health systems, nearly a third had an abnormal cytology and human papillomavirus co-test result, according to a study in Obstetrics & Gynecology.

“This study highlights a vulnerable population at high risk of recurrent cervical dysplasia,” Sarah Feldman, MD, MPH, and colleagues wrote.

The retrospective study investigated surveillance delivery for 3146 patients treated for high-grade dysplasia at Massachusetts General Brigham, Boston, Massachusetts, and Parkland Health, Dallas, Texas. Researchers analyzed data from 2010 to 2019 for the primary outcome: receipt of two negative co-tests after treatment within 30 months, which was recommended by the American Society for Colposcopy and Cervical Pathology until a 2019 update recommending three co-tests.

Overall, 45.5% of patients completed two surveillance co-tests within 30 months of treatment for high-grade dysplasia. Rates were 55.3% at Massachusetts General Brigham and 40.6% at Parkland Health.

Low Rates of Completion on Follow-Up Surveillance

Among patients with two surveillance co-tests, 31.3% received an abnormal result. By facility, rates for abnormal results were 30.9% at Massachusetts General Brigham and 31.6% at Parkland Health.

“Consistent with prior literature, these findings demonstrate that patients who have completed treatment for high-grade dysplasia remain at higher risk of cervical abnormality than their counterparts,” the researchers wrote, “and thus should not return to routine cervical cancer screening.”

Patients with two co-tests tended to be under observation longer than patients without co-tests. Overall, the median observation time was 64.3 months with two co-tests compared with 39.7 months without two co-tests.

The timing of surveillance co-testing was largely consistent with guidelines, the study found. The median time was 7.5 months between dysplasia treatment to first co-test and 12.0 months between the first and second co-test.

A total of 16 patients (0.5%) at both sites were diagnosed with cervical cancer after treatment for high-grade dysplasia. The median time from treatment to cancer diagnosis was 14.9 months.

“Although the sites served different patient populations (more Hispanic or Latino and Black populations and uninsured or publicly insured patients at Parkland Health compared with Massachusetts General Brigham) and geographic catchment areas, they demonstrated similar trends, a low completion of even two surveillance co-tests,” the researchers wrote, “making compliance with the newly recommended three tests even more unlikely.”