Treatment of moderate pre-cancerous cervical cells may be safely delayed without raising cancer risk, trial finds

by American College of Physicians

edited by Sadie Harley, reviewed by Robert Egan

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A target trial emulation study found that among women with cervical intraepithelial neoplasia (CIN) grade 2 (CIN 2), a moderate form of precancerous cervical dysplasia, excision within six months did not lower three-year cervical cancer risk compared with continued surveillance. Delaying treatment substantially reduced unnecessary cervical excisions. These observations suggest that it may be safe to delay treatment of CIN 2, especially lower-risk CIN 2. The findings are published in Annals of Internal Medicine.

Because not all CIN 2 progresses to cervical cancer, appropriate management is a topic of debate. Researchers from the National Cancer Institute analyzed data from 12,012 women in the Kaiser Permanente Northern California (KPNC) cervical cancer screening program diagnosed with CIN 2 on initial biopsy between 2017 and 2023, comparing immediate treatment (excision within six months) with delayed management (continued surveillance or excision after six months).

They estimated the three-year risk of unnecessary excision, CIN grade 3 or more severe, or invasive cervical cancer. Immediate treatment did not reduce three-year cancer risk but was associated with more excisions, yielding less serious findings, while delayed management reduced unnecessary procedures with careful follow-up. These findings may help inform U.S. guidelines on the best management of CIN 2.

Publication details

Benefits and Harms of Immediate Versus Delayed Treatment of Cervical Intraepithelial Neoplasia Grade 2: A Target Trial Emulation, Annals of Internal Medicine (2026). DOI: 10.7326/ANNALS-25-04053

Journal information: Annals of Internal Medicine

Key medical concepts

Cervical CancerActive surveillance

Clinical categories

Obstetrics & gynecologyWomen's healthCommon illnesses & PreventionReproductive health Provided by American College of Physicians Who's behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

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