Cervix Treatment May Endanger Pregnancy Later
'Watch and Wait' or Laser Are Often Best Options for Cervical Dysplasia
May 4, 2004 -- It's a common condition for women: cervical dysplasia, or precancerous cells on the cervix. Women should carefully consider the treatment options, however. Some could jeopardize a pregnancy later, a new study shows.
The report appears in this week's issue of the Journal of the American Medical Association (JAMA).
In it, researchers outline risks involved with three treatments for cervical dysplasia. It's a big issue for young women, since the abnormal growths are caused by a near epidemic of human papillomavirus (HPV) infections. An estimated 80% of people in the U.S. are infected with various strains of this common virus.
Researcher Lynn Sadler, MBChB, MPH, a professor of obstetrics and gynecology at the University of Auckland in New Zealand, outlines the treatments:
Laser conization and laser ablation involve "burning" precancerous cervical tissue with a laser.
LEEP (loop electrosurgical excision procedure) involves cutting tissue with a low-voltage electrified wire loop.
Doctors have long debated the effects of "chipping away" at the cervix -- since the cervix supports the developing fetus in the uterus during pregnancy. Do these treatments put the fetus in jeopardy? Could membranes rupture prematurely, causing premature delivery? Also, because glands in the mother's cervix that produce protective substances can be destroyed during treatment, is the fetus at risk for infection?
One expert offered his opinion on cervical dysplasia treatments: "If it was my wife or daughter I would encourage her not to have anything done. Many studies show that 75% of these precancerous cells go away on their own," says Ira Horowitz, MD, vice chairman and director of gynecologic oncology at Emory University's Winship Cancer Institute in Atlanta.
How Babies Fare
In looking at these issues, Sadler and her colleagues studied medical records for more than 1,000 patients seen at a New Zealand cervical cancer clinic during a 12-year period. All the women were diagnosed with cervical dysplasia. Nearly half -- 425 women -- were not treated for their cervical lesions; 652 were treated with laser conization, laser ablation, or LEEP.
Sadler and colleagues found a significant risk of premature membrane rupture leading to preterm delivery with single treatment with laser conization or LEEP: