Source: http://www.medicinenet.com
Surgeries to Remove Precancerous Cervical Lesions Raise Obstetric Risks
By Steven Reinberg
HealthDay Reporter
THURSDAY, Feb. 9 (HealthDay News) -- 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," said 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 (LEEP), 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 said 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 said. "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," she added.
One expert thinks the study points to a serious problem that has been
overlooked by many physicians who have been too eager to adopt LEEP as their
method of choice.
"This epidemic of LEEP procedures is virtually as dangerous as the cold
knife procedure," said 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 added.
Currently, doctors are using LEEP because that's what they were trained to
do, Goldstein said. "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 said. "Lasering or freezing of the cervix
doesn't have any of the risk."
Goldstein said doctors should think twice about using LEEP on young women.
"Think about whether you would want your daughter to have this procedure
before you do it," he said. "The pendulum needs to swing back."
For women, Goldstein's advice is to avoid LEEP during childbearing years.
"If you hear your doctor mention LEEP, perhaps you should question him or
her about the alternatives," he said. "In addition, mild lesions don't
always have to be treated, they can be watched," he added.
SOURCES: Maria Kyrgiou, M.D., department of obstetrics and gynecology, Royal
Preston Hospital, London, England; Steven R. Goldstein, M.D., professor,
obstetrics and gynecology, New York University School of Medicine, New York
City; Feb. 11, 2006, The Lancet
Copyright © 2006 ScoutNews LLC. All rights reserved.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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