Method for Treating Cervical Lesions May Pose Pregnancy Risks
FRIDAY June 6, 2008 -- A popular type of surgery for removing abnormal cells from the cervix -- a problem that could lead to cervical cancer if left untreated -- may put women at risk of pregnancy complications.
Women who had this procedure, known as loop electrosurgical excision procedure, or LEEP, were at greater risk of delivering preterm babies or having a low-birth-weight infant, according to British researchers.
Doctors should use caution in treating young women with mild cervical abnormalities or precancerous cells, the study authors concluded in a paper published recently in the medical journal The Lancet.
"Women should seek detailed information on efficacy but also on long-term pregnancy-related morbidity before they consent," lead study author Dr. Maria Kyrgiou of Central Lancashire Teaching Hospitals in Preston, Great Britain, told HealthDay.
LEEP is one of several surgical techniques for removing abnormal or precancerous cells from the cervix.
After numbing the cervix with local anesthesia, an electrically charged wire loop is inserted through the vagina, explains the American College of Obstetricians and Gynecologists. The loop, acting as a scalpel, cuts away a thin layer of tissue, removing the abnormal cells.
Other methods, including cold knife conization, laser ablation and laser conization, also remove or destroy suspect tissue while preserving cervical function, the British researchers noted. But the effect of these various treatments on future fertility and pregnancies has been unclear.
To assess the potential impact, Kyrgiou and her colleagues analyzed data from 27 previous studies.
Cold knife conization, which involves the excision of a cone-shaped piece of tissue, increased the likelihood of preterm birth and delivering a low-birth-weight infant by two-and-a-half times, and tripled the risk for Caesarean section, compared with women who did not have this procedure.
LEEP increased the risk of preterm delivery and delivering a low-birth-weight infant by 70 percent and 82 percent, respectively. It nearly tripled the likelihood of premature rupturing of the cervical membranes, the study authors found.
Laser conization, where a laser is used to cut away tissue, had similar outcomes, but the findings were not statistically significant.
Laser ablation, or using a laser to destroy abnormal tissue, was the only method that didn't increase pregnancy complications, the study authors said.
But at least two women's health experts cautioned about drawing conclusions from a study that involved pooling of data from multiple retrospective studies. And one warned about comparing obstetrical results among procedures used to treat different types of lesions, or tissue abnormalities.
"The appropriate study that would answer the question would be to compare LEEP and laser used for the same kind of lesion and the same size lesion done all at one institution," said Dr. Annekathryn Goodman, associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.
That said, Goodman underscored the importance of tailoring the treatment to the type of lesion: "So, small lesions only need small procedures, and larger lesions need big procedures." And, she added, "If the wrong treatment is done, and the lesion is not completely removed, the woman is at high risk for developing a cancer."
In her view, LEEP should be limited to treating women with high-grade precancerous lesions.
Dr. Carolyn D. Runowicz, director of the Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center, agreed that LEEP is needed to treat women with significant lesions to prevent an invasive cervical cancer. Women should also get a second opinion before undergoing a procedure, she said.
But the larger message, according to Runowicz, is for patients to prevent these lesions by getting regular screenings for cervical cancer.
And with the U.S. Food and Drug Administration's 2006 approval of Gardasil, a vaccine to prevent cervical cancer, woman have a powerful weapon against lesions caused by the human papillomavirus (HPV).
"HPV vaccine is the answer," agreed Dr. Joan L. Walker, chief of gynecologic oncology at the University of Oklahoma Health Sciences Center.
Posted: June 2008
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