Immediate Treatment vs Colposcopic Follow-up for Biopsy-Proven CIN 1

Inclusion Criteria:

• Eligible patients will:

• have documented CIN 1 by histologic assessment as the highest grade lesionpresent,

• have the lesion confined to the cervix and completely visualized,

• be 16 years or older.

Exclusion Criteria:

• any one of the following will be an excluding characteristic:

• index Pap smear showing CIN 2, CIN 3 or cancer;

• index Pap smear shows atypical glandular cells of unknown significance, glandulardysplasia, or malignancy requiring immediate investigation;

• patients with previously identified CIN 1 by biopsy who are already in acolposcopic surveillance program;

• unsatisfactory colposcopic exam defined as inability to see the extent of thelesion in the endocervical canal or absence of a lesion on the ectocervix butendocervical curettage shows CIN 1;

• pregnancy;

• prior therapy for dysplasia including medical (5FU), surgical (Laser, LEEP) orcryotherapy;

• prior gynecologic cancer;

• prior pelvic radiation therapy;

• inability to attend outpatient follow-up visits because of geographicinaccessibility;

• other malignancies except non-melanoma skin cancer;

• immunosuppression due to diseases such as AIDS, organ transplantation, or onimmunosuppressive medications such as prednisone, imuran or chemotherapy fordiseases like systemic lupus;

• cognitively impaired or otherwise unable to obtain written informed consent;

• extension of the CIN 1 lesion to vagina or a separate vaginal lesion showingdysplasia;

• colposcopically visible condyloma outside of the transformation zone;

• known allergy to local analgesics;

• clinically evident vaginitis must be treated and resolved prior to entry on thetrial;

• inability to read and respond in English/French;

• failure to provide informed consent.