The objective of this study was to determine whether those women who develo
ped cervical cancer following treatment for preinvasive disease had common
features in their history which could identify those at increased risk of p
rogression and therefore be used to modify management protocols. A retrospe
ctive case note review from clinical and histopathologic records was undert
aken at a teaching hospital in Wessex, Southern England. The review include
d 33 women diagnosed with cervical carcinoma between 1985 and 1996 who had
previously undergone treatment for cervical intraepithelial neoplasia (CIN)
or cervical glandular intraepithelial neoplasia (CGIN).
The diagnosis prior to treatment was CIN 3 in 19 cases, CGIN 3 in 2 eases,
CIN 2 in 9 cases (97% high grade CIN/CGIN) and CIN 1 in 1 case. At primary
treatment, among those treated by knife cone biopsy or Large Loop Excision
of the Transformation Zone (LLETZ), and for whom the margins of the treatme
nt specimen were reported, 14 out of 15 had incomplete margins. Local ablat
ion tin which completeness of excision treatment. Fifteen women had one or
more negative smears after treatment; of which only 6 had transformation zo
ne sampling. The interval between treatment of CIN/CGIN and diagnosis of in
vasion ranged from 8 to 216 months. (mean 40.4 months), with 67% of cases o
f invasive cancer occurring within 5 years of treatment for CIN/CGIN and 94
% within 10 years. Screen detection was achieved in 91% (30/33) of cases wi
th 53% diagnosed while stage 1A. In conclusion, most treatment screen detec
tion of invasive disease at an early (and often microinvasive) stage was ac
hieved for most patients, although a third of patients were diagnosed more
than 5 years after initial treatment. The data suggest the need to follow u
p longer than 5 years when there are risk factors such as incomplete excisi
on of high grade CIN/CGIN and in women over 40 years of age at the time of
initial diagnosis.