Includes bibliographical references / Aims and Objectives : To identify risk factors affecting rates of progression and regression of LSIL To determine the rates of progression and regression of disease in women with LSIL To compare the natural history of LSIL in HIV positive and negative women to determine patient adherence to colposcopy clinic in women with LSIL Methods: This is a retrospective, descriptive, cohort study of women who were referred to the colposcopy clinic with a cytological diagnosis of LSIL and followed for a minimum period of 2 years. Data was extracted from the colposcopy clinic data. Women who were referred and attended the clinic between 1st January 2009 and 31st December 2013 were included in the analysis. Statistical analysis was performed using Stata version 13.1 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA). All p-values <0.05 were deemed statistically significant. Results: The study population was 154 women with LSIL (N=154). Of these, 27 (17%) women were HIV negative, 106 (69%) were HIV positive and 18 had an unknown HIV status. The overall regression rate from LSIL to normality was 88.5% [95% CI = 83.9 - 92.1%], with 128 of the 154 women having had regression of disease. The overall progression to higher grade lesions included 31 women, giving a progression rate of 17.7% [95% CI = 15.4 -22.8%]. None of these women progressed to invasive cancer. HIV positive women made up 69% of the study population but there was no significant difference in regression and progression between the HIV positive and negative women. The mean age of the group was 37.8 years with 60% of women screened at this clinic falling between 30-49 years of age. All age groups had similar trends of regression and progression, but those over 60 years of age were 12 times more likely to regress and none of them progressed to HSIL [p=0.002]. Those using an IUCD made up 141 person-months studied, they were shown to have a 6 times greater likelihood to result in regression (p=0.01) compared to women on no contraception. Conclusion: The high regression and low progression rates of LSIL are in keeping with global data and substantiate the need for surveillance rather than surgical intervention i.e. LSIL is a risk factor rather than a precursor for cervical cancer. The lack of difference in regression-progression rates despite HIV status means we can follow-up positive and negative women similarly (12 monthly). Older women (60+) are most likely over-called during diagnosis due to genital atrophy and thus follow-up interval can be longer than 12 months. More research is required to assess IUCDs' effect on LSIL regression and to ascertain the possible reasons for patient adherence.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/16526 |
| Date | January 2015 |
| Creators | Govender, Kamendran |
| Contributors | Denny, Lynette |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Obstetrics and Gynaecology |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MPhil |
| Format | application/pdf |
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