The challenge of achieving good outcomes

S ince the development and wide implementation of cervical cancer screening programs, cervical cancer rates have decreased by up to 80%.1 Screening has increased the identification of cervical intraepithelial neoplasia (CIN), carcinoma in situ (CIS), and cervical dysplasia in young women during their reproductive years. In fact, the International Federation of Gynecologists and Obstetricians (FIGO) 2006 annual report showed that 49% of all cases of cervical carcinoma worldwide occurred in women younger than 49 years.2 This is a challenging situation given that the age of nulliparous women has increased.2 The data point to the need for conservative fertility-preserving management of cervical dysplasia and carcinoma, especially in preinvasive and microinvasive disease. While the therapies used to treat cervical disease have high success rates, they also carry a risk for long-term morphologic damage that may in turn result in gynecologic and obstetric complications, including cervical stenosis, preterm delivery, and low birth weight. This article reviews the ablative and excisional procedures used to treat cervical disease, their potential adverse impact on reproductive and fertility outcomes, and what guidance the literature offers regarding tailoring treatment to minimize residual disease and improve the chances of good gynecologic and obstetric outcomes.