The success of any cervical cancer screening program is best estimated by the impact of screening on cervical cancer rates. Cancer prevention is relatrively unique to cervical cancer screening as compared to most other screened for cancers. To prevent cervical cancer one must identify and treat precancer. The efficacy of treatment is today, often balanced against the risk of adverse outcomes associated with treatment. In current practice in developed countries, treatment of precancer is effectd by excision rather than ablation. The advantages of excision is that one can assess the completeness of the excison, orrelate the pathology with prior specimens and detect occult carcinoma. This presentaion will explore the litertaure based data that predict the risk of recurrence following excisional therapy
The literature on the risk of recurrence after treatment, primarily short term risk will be defined via literature review.
HIstorically, the primary indicator of recurrence risk was the status of the margins of the conization. However there are other variables that impact these estimates including the type of excison, size of the excison, how the specimen is processed, and distance of the precancer from the margin if the margin is negative. Whether the lesions is squamous or glandular is also important. Age and colposcopic adequacy are important factors as well. Currently all post-treatment follow-up strategies recommned cytology with or without HPV testing as an indicator of success iof threatment. While even these assessments are confounded, the post-treatment samples may actually be superior to margin assessmt of the excision specimen for predicting recurrence risk.
Clearly treatment works as documented by the success of the screening systems in most screening programs. But within the treated cohort ,multiple factors interact to impact the short term success or failure of treatment as measured by shore term reurrence rates. Accurate assessment can be highly confounded by several factors, mostly related to the size of the excision and the anatomy of the cervix. The historical utility of margin assessment is debatable in the era of electrosurgery.