12-Year Study Suggests Procedures to Prevent Cervical Cancer Do Not Affect Fertility
Common surgical procedures used to diagnose and treat precancerous cervical lesions do not decrease women's chances of becoming pregnant, according to a study conducted by Kaiser Permanente Northwest, which followed nearly 100,000 women for up to 12 years. In fact, researchers found that women who underwent one of these procedures were more likely to become pregnant than women who were not exposed to treatment or diagnostic procedures. The findings of the study are published by Naleway et al in PLOS ONE.
Treating Precancerous Cervical Lesions
According to the Centers for Disease Control and Prevention, about 3 million women in the United States will have an unclear or abnormal Papanicolaou test each year. Many of them will go on to have a diagnostic colposcopy and biopsy to determine whether they have precancerous lesions on their cervix. If these lesions are found, the women may have a loop electrosurgical excision procedure (LEEP), cryotherapy, or another surgical procedure to remove the cells so they do not progress to cervical cancer.
“This is great news for the millions of women who have one of these procedures but still want to have a family,” said Allison Naleway, PhD, lead author and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. “There was a fear that these procedures could weaken the cervix and reduce fertility, but our study suggests that this is not the case.”
Study Findings
The researchers examined medical records for 4,137 women between the ages of 14 and 53 who were members of the Kaiser Permanente health plan in the states of Oregon and Washington. The women selected were members of the plan between 1998 and 2009 and had had a cervical treatment procedure. The investigators followed the women for up to 12 years after the procedure to find out whether they became pregnant and compared those women with 81,435 women in the health plan who did not have a cervical treatment procedure and 13,676 who had a colposcopy or biopsy diagnostic procedure.
Of the women who had cervical treatment procedures, 14% got pregnant, compared with 9% of women who did not have a procedure and 11% of women who had a biopsy or colposcopy. After adjustments were made for age, contraceptive use, and infertility, women who had a treatment procedure were still almost 1.5 times more likely to conceive compared with untreated women. Pregnancy rates among women who had a biopsy or colposcopy were the same as rates among women who had a surgical treatment procedure.
“While the data we collected did not include sexual history, it is possible that the women who had these procedures may have been more sexually active than the untreated group, and that would explain the higher pregnancy rates,” Dr. Naleway said.
This is the largest study to date to examine whether these surgical procedures decrease fertility. Other, smaller studies have relied on patient recall and survey data rather than examination of medical records.
Researchers also examined whether these procedures affected birth outcomes such as preterm delivery. Results of that study are expected later in 2015.
Dr. Naleway is the corresponding author of the PLOS ONE article.
This study was funded by a grant from GlaxoSmithKline. For full disclosures of the study authors, visit journals.plos.org/plosone.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
