Preventable Risk Factors: Retrospective Analysis of a Cohort of 21 Cases of Cervical Low-Grade Squamous Intraepithelial Lesions

Abstract

Objective: In 2020 we had reported that with non-invasive integrative management, 20 out of 21 cases of Low-grade Intraepithelial Squamous Lesions (LSIL) of cervix responded, whilst one case discontinued early. Subsequent to the analysis by Global Collaborative Group on Cancer Risk Factors in 2022, we report retrospective analysis of Preventable Risk Factors (PRFs) in this cohort.

Materials and Methods: We graded each PRF from 0 to 3 scores as per the severity with grade 0=no risk, 1=minor risk, 2= moderate risk and 3= definite risk. Sixteen PRFs for cervical cancer were scored in all cases into 4 grades. The treated 20 cases were classified in 3 groups according to Pap smear changes- Group 1: persistent LSIL/non-responders (n=2); Group 2: regression to Atypia (n=9); Group 3: responders/regression to negative smears (n=9).

Results: Single or multiple PRFs, other than LSIL in Pap smear at enrolment, were present in every case. Some common PRFs in this cohort were cervico-vaginal infection (21/21), overweight/obesity (11/21), Unhealthy diet (3/21), raised serum IL-6 (3/21) etc. The mean±SD total risk score after grading in Group 1 was 14.5±3.53 vs 10.44±4.66 in Group 2 vs 10.62±1.22 in Group 3.

Mann Whitney U test: p value = 0.051 indicated a nonsignificant trend towards higher risk scores in Group 1 vs Group 3.

Conclusion: All LSIL cases had single or multiple risk factors at initial examination. The total scores of graded PRFs were slightly higher in the persistent LSIL group than in treatment responders, just short of statistical significance. It may be difficult to screen and advise all women to reduce PRFs due to unmanageable numbers. Therefore, at least all screen positive cases should be advised on possible consequences of PRFs. Downgrading PRFs may reduce recurrences and progression to invasive cancer. Some PRFs are common to other cancers and non-communicable diseases hence there are multiple health benefits of such a policy.