Browsing by Author "Ellis, Laura Burney (57944472900)"

Histological diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) has traditionally been the cutoff for local surgical treatment, due to a substantial risk of cancer development. However, evidence from the past decade suggests 50–60% of CIN2 lesions spontaneously regress, and active surveillance (or conservative management—ie, leaving the lesion untreated) might be justified in some cases. Active surveillance of CIN2 lesions is now practised widely, although clear recommendations on eligibility, frequency of surveillance, threshold for treatment, and criteria for return to routine recall are insufficient in most countries. In 2023, the cumulative risk of invasive cancer over 20 years was found to be substantially higher in patients under active surveillance when compared with patients who received immediate local treatment, with the greatest difference observed in women older than 30 years. This Policy Review and practice algorithm from the British Society of Colposcopy and Cervical Pathology and the European Society of Gynaecologic Oncology prevention committees aims to review existing evidence and present clear recommendations to assist clinical decision making. Active surveillance, rather than immediate treatment, might be reasonable in a carefully selected cohort of patients. The risk of progression, need for repeat visits, and cumulative risk of future invasion associated with active surveillance should be carefully balanced against the benefits of awaiting regression, including consideration of the woman's age, fertility wishes, additional risk factors, and likelihood of compliance to follow-up. Clinical audit and, ideally, prospective databases are required to monitor long-term outcomes and safety. © 2025 Elsevier Ltd

Background: Vulvar squamous cell carcinoma incidence is increasing, especially among women under 60, largely attributed to human papillomavirus infections. Precursor pre-invasive vulvar lesions are frequently underdiagnosed. Routine vulvar inspection during cervical cancer screening could offer an opportunity for the detection of these lesions. Objective: To emphasize the importance of integrating routine vulvar inspection during cervical cancer screening procedures and to raise awareness about the early detection of vulvar squamous cell carcinoma and its precursors to reduce the diagnostic delay of vulvar pathologies. Methods: A multidisciplinary task force comprising experts from 4 international scientific societies was formed. A focused literature review was conducted, and consensus statements were developed through a structured voting process to ensure clinical relevance and comprehensiveness. Results: The consensus defines key elements of normal vulvar anatomy, identifies potential pre-cancerous dermatoses, and highlights risk factors for vulvar malignancy. The consensus statements promote the integration of vulvar inspection into cervical cancer screening procedures, urging health care professionals across various levels to receive training and guidance in vulvar examinations and enhancing patient education. Health care providers are recommended to gather a brief history of vulvar symptoms, conduct comprehensive inspections of the vulvar area, and report any abnormalities. For patients with positive human papillomavirus or Pap tests, they should closely monitor vulvar findings, encourage self-examinations, and discuss risks for intra-epithelial or invasive neoplasia. Conclusions: Establishing standardized practices in vulvar inspection during cervical cancer screening procedures along with public awareness, could significantly impact early detection and timely interventions of vulvar pathologies at cancer risk ultimately reducing the burden of vulvar cancers. © 2024 European Society of Gynaecological Oncology and the International Gynecologic Cancer Society