Victoria Wang, Jacquelyn M. Lykken, Jasmin A. Tiro, Rebecca B. Perkins, Jennifer S. Haas, Claudia Werner, Sarah C. Kobrin, Sarah Feldman
4 min
Patients treated for high-grade cervical dysplasia (such as CIN 2-3 or HSIL) remain at a significantly elevated risk of developing cervical cancer compared to the general population. To manage this risk, clinical guidelines mandate a period of close surveillance, typically involving multiple co-tests (HPV testing combined with cytology) in the years following treatment. This study sought to determine the real-world adherence rates to these surveillance guidelines by analyzing longitudinal data from 3,146 patients treated for high-grade dysplasia between 2010 and 2019 across two diverse U.S. health care systems: an academic medical center (Massachusetts General Brigham) and a public safety-net system (Parkland Health).
The researchers found that adherence to recommended surveillance is alarmingly low. Across both study sites, only 45.5% of patients completed the required two surveillance co-tests within the 30-month window following their treatment. Adherence rates varied by site, with 55.3% completion at the academic center versus 40.6% at the safety-net system.
Crucially, among the patients who did manage to complete the two-test surveillance protocol, approximately one-third received at least one abnormal result, confirming that this population remains at high risk for persistent or recurrent disease. While the overall incidence of cervical cancer in the cohort was low (0.5%), the findings underscore that many patients are falling out of the necessary follow-up care, leaving them vulnerable to undetected progression.
These results demonstrate a significant gap between clinical guidelines and actual patient care. Because patients treated for high-grade dysplasia are at a persistent, twofold to fivefold increased risk of cervical cancer, returning to routine, less-frequent screening is insufficient. The low rate of guideline-concordant surveillance suggests that current health care delivery models are failing to keep these high-risk patients engaged. The study highlights an urgent need for systematic improvements—such as better patient education, targeted outreach, and improved continuity of care—to ensure that these patients receive the long-term monitoring required to prevent future cancer diagnoses.
Sam: Fair point, and it is closely tied to the paper's main limitation. The authors acknowledge they can't account for patients who leave through insurance changes or geographic mobility. So some of the 45.5% likely reflects care received elsewhere, which means true adherence is probably somewhat higher. The authors still read the remaining gap as a continuity problem.
Alex: But even if some patients are being seen elsewhere, the system isn't facilitating that handoff. It is just losing track of them.
Sam: That is the argument. Continuity falls on the patient. The discussion also raises logistical barriers, like parking and childcare, that coverage of the tests themselves doesn't address. In effect, resources go to the diagnostic procedure and not to the infrastructure that keeps someone in a multi-year cycle.
Alex: And the proposed remedy?
Sam: Registry-based approaches that do more than record data. They would trigger alerts to both clinicians and patients, so follow-up doesn't depend on someone remembering a twelve-month window. It's a recommendation, not something this study tested. The evidence supports the size of the problem and the argument that passive systems produce it. Whether automated tracking closes the gap is a separate question for prospective work.
Alex: So the study establishes a large surveillance gap in two very different settings, and that gap is the part the data support best. If you want the figures and the method choices we skipped, you can generate a deep dive of this paper. The paper has the rest either way.
Sam: Thanks for listening.