Victoria Wang, MD, discusses surveillance for high-grade dysplasia

In a recent interview with Contemporary OB/GYN, Victoria Wang, MD, gynecology oncology fellow at Brigham & Women’s Hospital, discussed trends in guideline-concordant surveillance following treatment for high-grade dysplasia.

Wang highlighted a guideline shift to include 3 co-tests after treatment rather than 2. This allows identification of the more persistent CIN3+ population after treatment. She recommended clinicians provide unique treatment to their high-risk patients compared to the baseline population.

Contemporary OB/GYN:

What trends in guideline-concordant surveillance after treatment for high-grade dysplasia have been observed?

Victoria Wang, MD:

Yeah, in 2019, the ASCCP made a guideline shift to include 3 co-tests after treatment for high grade dysplasia from 2. And really in making that shift, the goal was to capture more of the persistent CIN3+ population that remains after treatment. We wanted to look at whether or not these guidelines were easy to adhere to, and what the compliance rates were for these new guidelines.

Contemporary OB/GYN:

How do low surveillance rates after treatment for high-grade dysplasia impact patient health?

Wang:

We know that patients who have high grade dysplasia and receive treatment have a high chance of recurring either in dysplasia or in cancer. We found that recurrence rates can be as high as 25%, so making sure that they’re completing their guideline concordant care and really doing those surveillance protests can be a really important component in capturing those patients before they progress cervical cancer.

Contemporary OB/GYN:

How have cervical cancer incidence and mortality trends shifted over time, and how has advanced screening impacted these trends?

Wang:

Yeah, it’s a really unique situation, cervical cancer, because we have a primary and secondary prevention technique that has allowed us to really decrease the rate of mortality and incidence, but still, we have a persistent number of cases in the United States every year due to a combination of low vaccination rates, inability to adhere to screening guidelines, and misdiagnoses. So, identifying places that we can really implement action plans and quality improvement to bridge those gaps will really help us go a long way in eliminating cervical cancer entirely.

Contemporary OB/GYN:

How can clinicians improve surveillance rates in their patients?

Wang:

I think every provider knows their own practice best, and I’m hoping that this study will help people brainstorm new ways that they can target a particularly high-risk population within their patients. Those patients who have gotten treatment for high grade dysplasia really shouldn’t be treated the same as the baseline population, even after they’ve had a negative co-test. Making sure that those patients remain on your high risk follow up list and they get the proper education materials to advocate for themselves In the future about what their baseline risk is, I think this study really demonstrates that they have a persistent recurrence risk far beyond just the 2 years.

Contemporary OB/GYN:

Is there anything you would like to add?

Wang:

I think one important thing to note from the study data is that even though the overall number of cervical cancer cases were low, more than half of those cases were diagnosed in the first 6 months after treatment. I think it really highlights that critical period of time. So that first co-test right after treatment in six months is really the most critical component in capturing those patients who have had a persistence or recurrence in CIN3+.

No relevant disclosures.

Reference

Wang V, Lykken JM, Tiro JA, et al. Guideline-concordant surveillance after treatment for high-grade cervical dysplasia. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.