Individualised care for cervical precancer

Decision to treat surgically should be weighed against the rate of complications The introduction of organised cervical screening programmes has enabled the early diagnosis and treatment of cervical intraepithelial neoplasia (CIN), reducing the incidence of invasive cervical cancer and mortality from the disease.1 However, surgical treatments for CIN that excise a cone shaped part of the cervix are not without complications. In a large linked study from Denmark (doi:10.1136/bmj-2023-078140), Aagaard and colleagues obtained data from nationwide registries and investigated short and long term complication rates after conisation for CIN.2 Τhe authors compared the outcomes for more than 48 000 women who underwent conisation with a matched population who had colposcopically directed biopsy alone. The authors explored long term outcomes that included cervical stenosis, fertility related consultations or treatment, infertility diagnosis, and death. The adjusted incidence rate ratio of cervical stenosis for treated women compared with untreated women was 12.6. This risk increased with age and increasing number of conisations. Data on the treatment technique, length of excision, and menstrual phase at operation3 were not recorded in the registry and were not reported. The use of cervical sutures to control intraoperative or postoperative bleeding …