Recurrence of cervical precancer after excisional treatment: risks and prevention

Background. Genital papillomavirus infection is widespread in the population, initiating the development of precancer and genital cancer. The vast majority (83.0%) of human papillomavirus-related cancer cases worldwide are cervical cancer. The review article presents a modern approach to the management of patients after excisional treatment for cervical precancer. Recurrence of cervical precancer after surgical treatment occurs in 8.1-14.4% of cases, which increases the risk of developing cervical cancer. Despite the high effectiveness of local surgical treatment of patients with cervical precancer, an increased risk of late diagnosis of cervical cancer has been proven in comparison with the risk in the general population. Data are presented on factors that increase the potential risk of recurrence of cervical precancer: age of women over 50 years; follow-up results confirming the presence of high-risk human papillomavirus and high viral load, as well as HPV co-infection and abnormal cytology; positive resection margin resulting from excisional treatment of cervical intraepithelial neoplasia. Human papillomavirus persistence is considered one of the leading predictors of relapse of CIN2+, regardless of the type of excision treatment. The combination of persistent high-risk human papillomavirus and a positive sectional margin significantly increases the risk of persistent/recurrent CIN2+. The importance of a positive endocervical margin as a predictor of relapse is emphasized. A negative co-test (cytological examination in combination with an human papillomavirus test) after conization in the dynamics of observation contributes to a favorable prognosis. It was found that in patients with a negative human papillomavirus test and a negative result of a cytological study, the development of cervical precancer was observed in only 0.2% of cases over the next 42 months after conization, which was lower than the incidence of cervical precancer among patients participating in a population-based cervical cancer study screening. Foreign authors include preventive vaccination against human papillomavirus as anti-relapse measures with a bivalent vaccine (against types 16 and 18) or a quadrivalent vaccine (against types 6, 11, 16 and 18), which reduces the risk of relapse of CIN2+ associated with human papillomavirus 16 and human papillomavirus 18, compared with unvaccinated people. The issues of post-excision vaccination based on the results of a number of meta-analyses are discussed. Despite the positive effects of human papillomavirus vaccination, it has not been determined whether post-treatment human papillomavirus vaccination should be recommended for all women undergoing excisional treatment for intraepithelial neoplasia. The assessment of the effectiveness of the preventive vaccine for patients with an initially positive test for human papillomavirus types 16 and 18 requires clarification. It is recognized that the development of this promising area requires continued research to clarify the time of administration of the vaccine dose relative to excision.
Conclusion. Аn integrated approach, including detection of cervical human papillomavirus infection after excisional treatment of intraepithelial neoplasia and subsequent active surveillance, avoids relapses and progression of cervical precancer. Post-excision vaccination against human papillomavirus is recognized as a promising approach for secondary prevention of cervical precancer.

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