Cervical lesions change fastest in Hispanics, slowest in blacks—for better and worse

January 11, 2018, American Osteopathic Association
Hispanic women progressed the fastest, moving from the innocuous ASC-US stage to worrisome HSIL 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 HSIL to ASC-US lesions in 28.1 months. On average black women took 49 months to regress back to that stage. Credit: Journal of the American Osteopathic Association

Physicians determining treatment options following abnormal Pap smears now have another factor to consider: the patient's race.

According to new research in The Journal of the American Osteopathic Association, the rates at which in the cervix progress toward becoming cancerous or regress toward normal vary among Hispanic, black, white, and Asian .

The study analyzed medical records of 5472 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 HSIL to ASC-US stage.

"We see race-based differences that influence 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 have not yet benefited from that additional layer of context. This study is a first step toward more precise and effective care."

Hispanic women progressed the fastest, moving from innocuous to worrisome high-grade lesions within 17.6 months, whereas 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 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.

Tipping the scales in risk assessment

Precancerous lesions are caused by the human papillomaviruses (HPV) and can lead to cervical cancer. Often the immune system is able to fight off the virus, and when it does, precancerous lesions tend to regress back to normal cells.

This is why, when precancerous lesions are discovered, the next step is usually to test for HPV. Physicians determine their recommendation for treatment by calculating risk, which depends on the stage of the lesion and whether HPV is still present.

Aggressive treatment usually involves excising the lesion. While this effectively eliminates the risk for developing cancer, it also compromises the cervix and can negatively affect reproductive health—especially if the procedure is done multiple times over a patient's life.

Tailored treatment

"Precancerous lesions in black women seem to take a significantly longer time to progress to a dangerous level," said Dr. Martingano. "In cases of abnormal cells and low grade lesions, we have a lot more latitude to give their bodies time to fight the virus and recover on their own."

Conversely, he says Hispanic women who have low grade and test positive for HPV should probably be treated more aggressively as they worsen the fastest.

"We know different groups of people follow different trajectories in relation to disease progression," said Dr. Martingano. "Whenever we are able to tailor our treatment accordingly, it's always the most beneficial approach for our patients."

Explore further: HIV status may affect the progression of HPV infection to cervical pre-cancer

More information: Daniel Martingano et al, Variations in Progression and Regression of Precancerous Lesions of the Uterine Cervix on Cytology Testing Among Women of Different Races, The Journal of the American Osteopathic Association (2018). DOI: 10.7556/jaoa.2018.003

Related Stories

HIV status may affect the progression of HPV infection to cervical pre-cancer

June 1, 2017
A study of Senegalese women showed that human papillomavirus (HPV) infection was more likely to develop into cervical pre-cancer in women living with human immunodeficiency virus.

Vaccine clears some precancerous cervical lesions in clinical trial

September 17, 2015
Scientists have used a genetically engineered vaccine to successfully eradicate high-grade precancerous cervical lesions in nearly one-half of women who received the vaccine in a clinical trial. The goal, say the scientists, ...

Screening for cervical abnormalities in women offered HPV vaccination

September 19, 2017
Human papillomavirus (HPV) testing detects a higher number of precancerous cervical lesions than cytology-based Pap smears in a female population including a proportion offered HPV vaccination, according to a new study published ...

Most anal lesions don't cause cancer in men, research shows

March 23, 2012
(HealthDay) -- Anal human papillomavirus (HPV) infection and precancerous lesions are common among gay and bisexual men, but most of these cases will not progress to anal cancer, a new analysis of earlier research shows.

Study outlines recommendations for precancerous treatment of anal lesions

September 27, 2017
Currently, no guidelines exist for screening and treatment of precancerous anal lesions or for anal cancer screening because enough is not known about the effectiveness of treating lesions detected through screening. A new ...

Increased oral pathogens, decreased bacterial diversity predict precancerous stomach cancer lesions

November 27, 2017
Elevated pathogen colonization and a lack of bacterial diversity in the mouth were identified in people with precancerous lesions that could precede stomach cancer, finds a new study led by New York University College of ...

Recommended for you

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.

The pill lowers ovarian cancer risk, even for smokers

January 18, 2018
(HealthDay)—It's known that use of the birth control pill is tied to lower odds for ovarian cancer, but new research shows the benefit extends to smokers or women who are obese.

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.