Factors Associated with Non-Regression of Cervical Intraepithelial Neoplasia Grade I After One Year of Expectant Management

Open Access

Abstract

Background: Cervical intraepithelial neoplasia grade I (CIN1) is known to have a high rate of spontaneous regression, and expectant management is a viable option for women of reproductive age. However, there is limited understanding of factors that predict non-regression in South Asian populations. This study aimed to assess the histopathological results of expectant management of CIN1 after one year and to identify the factors associated with non-regression. Methods & Materials: This prospective observational study was conducted at the Gynecological Oncology OPD of the National Institute of Cancer Research and Hospital from January 2023 to December 2023, involving 71 women who had a histologically confirmed CIN1. Participants were managed expectantly, and a repeated cervical biopsy was performed after 1 year. Demographic, reproductive, contraceptive, lifestyle, gynecological, and human papillomavirus (HPV) data were compared between regression and non-regression groups. Data were entered and analyzed on SPSS version 26. Results: Regression was seen in 69.1% of women, persistence in 26.7%, and progression to CIN2 in 4.2%. Non-regression was significantly associated with older age (36.84 vs 31.06 years, p<0.001), age at marriage below 16 years (p=0.019), oral contraceptive use for five years or more (p=0.011), tampon use (p=0.035), and high-risk HPV positivity (p=0.040). There was no significant association with parity, age at first delivery, condom use, smoking, malodorous discharge, or genital warts. Conclusion: Most women with CIN1 will spontaneously regress within 1 year, making expectant management the first-line approach. Older women, married early, using oral contraceptives for a long time, using tampons, and having a long history of high-risk HPV infection are at higher risk of non-regression and may require more frequent monitoring.