American Society for Colposcopy and Cervical Pathology

View all recommendations from this society

February 14, 2017

Avoid treatment of CIN 1 in women under age 25.

Regardless of prior cytology, treatment of cervical intraepithelial neoplasia grade 1 (CIN 1) in women aged 21–24 years is not recommended. CIN 1 is the histologic manifestation of HPV infection, and like HPV infection in young women regression rates are high. It is uncommon for these lesions to progress.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

As a national medical specialty society with membership across multiple disciplines and differing healthcare providers, including doctors and advanced practice nurses, the ASCCP (The Society for Lower Genital Tract Disorders) relies on input from its committee structure and governance for document development. For the Choosing Wisely campaign, the list was obtained through expert discussion of members of the Practice Committee. A literature search was conducted related to each item. The list was then ratified by the Society’s Executive Committee and Chief Medical Officer. Due to the complexity of language around cervical cancer screening, several items use more than one term to describe the same concept (i.e., cervical cytology/Pap test, and high-grade cervical dysplasia/CIN 2/3). This was done intentionally to avoid confusion, and the statements include all terms thought to be important by members of the ASCCP. All comments from the Executive committee were incorporated into the final approved list.

Sources

Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121:829-46.

Moscicki AB, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, et al. Regression of low-grade squamous intraepithelial lesions in young women. Lancet. 2004;364:1678-83.

Cox JT, Schiffman M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol. 2003;188:1406-12.