Race and abnormal Pap results: New study offers a connection

A woman’s race may be a factor in tailoring care for patients with cervical lesions, according to new research on the progression and regression of precancerous cells in the cervix.

According to a peer-reviewed study in The Journal of the American Osteopathic Association, the rates at which precancerous cells in the cervix progress toward becoming cancerous or regress toward normal vary among Hispanic, black, white, and Asian women.

The retrospective cohort study analyzed medical records of 5,472 women receiving a Pap test between January 2006 and September 2016, and charted the progression of abnormal cell development, from the atypical but innocuous (ASC-US) lesions to low-grade (LSIL) to high-grade (HSIL), the type most likely to develop into cancer. Researchers also studied the rates at which lesions regressed from high-grade to innocuous.

“We see race-based differences that influence treatment protocols in all manner of health issues,” said Daniel Martingano, DO, an ob-gyn at New York University Langone Hospital-Brooklyn and lead author on this study. “Unfortunately, screening and treatment guidelines for precancerous lesions have not yet benefited from that additional layer of context.”

Cervical lesions and cancer

Cervical cancer can almost always be attributed to Human papillomavirus (HPV) infection, the most common viral infection of the reproductive tract and one that many sexually active men and women will contract.

There are many types of HPV infections, the majority of which do not cause symptoms or disease and resolve on their own. However, persistent infection with specific types of HPV (most frequently types 16 and 18) may lead to precancerous lesions. If untreated, these lesions may progress to invasive cervical cancer, though this progression usually takes many years, according to the World Health Organization.

Preventing cancer through effective care

This study could potentially be a step toward more precise and effective care for women who have developed cervical lesions. For example, women whose cervical lesions may progress to cervical cancer fastest could benefit from more aggressive treatment or surveillance options and women whose lesions are likely to change more slowly may opt for less invasive procedures and fewer screenings.

According to the study, Hispanic women progressed the fastest, moving from innocuous to worrisome high-grade lesions within 17.6 months, whereas black women took 27.6 months to reach that critical state. However, Hispanic women recovered faster too, regressing from high-grade to innocuous lesions in 28.1 months. On average black women took 49 months to regress back to the innocuous stage.

Progression and regression rates of precancerous lesions for white and Asian women fell in between, reflecting more closely the expected patterns upon which current treatment guidelines are based.

Dr. Martingano says his research may help physicians feel more confident in making their treatment decisions and hopes it leads to fewer women undergoing aggressive and invasive procedures.

For full details, read the complete original research, “Variations in Progression and Regression of Precancerous Lesions of the Uterine Cervix on Cytology Testing Among Women of Different Races.”