AUTHORS PERSPECTIVE

摘要

Sometimes less is more: Abnormal cervical smear test results and cervical lesions that potentially warrant intervention are common. For instance, in England alone approximately 3.6 million women aged 25 to 64 annually attend cervical screening, and almost 24 000 cervical procedures are carried out.Although the intention is to prevent problems, these smear test results also generate anxiety and concern, as well as cost. Historically, almost all changes detected in cervical smears were treated. However, as our evidence base has developed, it has become apparent that the mildest uterine cervical lesions typically regress spontaneously. This finding has shifted clinical practice guidelines to a more conservative approach with active surveillance, and surgical treatment only if the lesion persists or progresses. Simultaneously, an increasing body of evidence has emerged suggesting that even moderate precancerous lesions (cervical intraepithelial neoplasia grade 2, CIN2) may regress, especially in young women. A robust synthesis of evidence for this approach, however, has been lacking.