Surgeries to remove precancerous cervical lesions raise obstetric risks

Some of the most common methods used to treat precancerous cells of the cervix may also greatly increase risks for problem pregnancies, researchers report.

In recent years, cervical screening programs and treatment of precancerous cells have dramatically reduced the incidence of cervical cancer.

Using techniques such as cold-knife or laser conization (where a cone-shaped piece of cervical tissue is removed), laser ablation, or loop electrosurgical excision procedure (cutting away cervical tissue using a fine wire loop plus a low-energy current), doctors have been able to successfully remove or destroy abnormal cells while preserving cervical function, the researchers noted.

All these techniques are equally successful in preventing progression to cervical cancer; however, their effect on future fertility and pregnancy problems has been unclear.

The results of a new British study in the Feb. 11 issue of The Lancet find that several of these techniques may be responsible for a variety of problems during pregnancy.

"All the conservative excisional methods of treatment that remove part of the cervix, together with the transformation zone containing the abnormal precancerous cells, have more or less similar unfavorable effects on future pregnancy, while laser ablation was not associated with an increased risk of pregnancy-related morbidity," says lead researcher Dr. Maria Kyrgiou, from the department of obstetrics and gynecology at Royal Preston Hospital in London.

In the study, Kyrgiou and her colleagues analyzed data from 27 previous studies. They found that cold-knife conization increased a woman's risk of both preterm delivery and delivering a low birth-weight baby by two-and-a-half times, and tripled the risk of Cesarean section, compared to women who did not have the procedure.

In addition, loop electrosurgical excision procedure, the most popular treatment, increased a woman's risk of both preterm delivery and delivering a low birth-weight infant by between 70 percent and 80 percent, and nearly tripled the risk for premature rupturing of the cervical membranes, compared to women who did not undergo this procedure. Laser conization had similar effects, but they were not as severe, the researchers found.

Of all the methods, only laser ablation (laser removal of tissue) did not increase the risk for pregnancy complications.

Kyrgiou says a woman needs to talk over her options with her doctor, especially since invasive surgeries are not always required for less-suspicious lesions.

"The treatment of precancerous lesions is necessary for the prevention of cervical cancer," she says. "However, it should be performed when it is necessary and appropriate by experienced clinicians, as a large proportion of low grade/mild lesions will eventually regress back to normal.

"Women should seek for detailed information on efficacy, but also on long-term pregnancy related morbidity before they consent," Kyrgiou adds.

One expert thinks the study points to a serious problem that has been overlooked by many physicians who have been too eager to adopt loop electrosurgical excision procedure as their method of choice.

"This epidemic of loop electrosurgical excision procedure procedures is virtually as dangerous as the cold-knife procedure," says Dr. Steven R. Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine, in New York City. "The abandonment of laser vaporization and cryosurgery for early surgical disease is scary and dangerous," he adds.

Currently, doctors are using loop electrosurgical excision procedure because that's what they were trained to do, Goldstein says. "In young women, you start cutting on their cervix instead of freezing or vaporizing on the cervix, and you are going to see adverse obstetrical outcomes," he says. "Lasering or freezing of the cervix doesn't have any of the risk."

Goldstein says doctors should think twice about using loop electrosurgical excision procedure on young women. "Think about whether you would want your daughter to have this procedure before you do it," he says. "The pendulum needs to swing back."

For women, Goldstein's advice is to avoid loop electrosurgical excision procedure during childbearing years. "If you hear your doctor mention loop electrosurgical excision procedure, perhaps you should question him or her about the alternatives," he says. "In addition, mild lesions don't always have to be treated, they can be watched."

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c.2006 HealthDay News