Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years



We are pleased to see interest in the important subject of excision margin status and recurrence after treatment for cervical intraepithelial neoplasia (CIN).1 There is still significant mortality from cervical cancer in the UK despite an excellent screening programme. This may be, in part, due to failure of effective treatment and follow up of CIN. The authors report higher recurrence rates with involved margins in women over the age of 50. In a large meta-analysis on this subject, we have shown a significant effect from incomplete excision leading to higher risk of recurrence in all age groups, particularly in high-grade lesions involving the endocervical margins.2 Although the emphasis of this recent study1 is on risk of recurrence in older women, involved margins in women under the age of 50 should not be overlooked and second treatment should be considered for these women also on individual basis.

It is noteworthy that recurrence of CIN continued to occur up to 80 months post-excision in the study of Manchanda et al.1 This reiterates the need for close long term follow up of these women regardless of resection margins.

In view of the high recurrence rate in women with involved margins at any age and given findings from the study by Soutter et al.3 in our view, colposcopy should be recommended in the long-term follow up of women for whom repeat excision is not performed.