Different Risk Factors Associated with Persistence or Regression of Squamous Intraepithelial Lesions of Cervix under Rural Conditions in India

Abstract

Introduction: In many Human Papilloma Virus (HPV) negative women, the Squamous Intraepithelial Lesions (SIL) of cervix often show persistence or progression of the lesion on follow-up which shows involvement of other risk factors of carcinoma cervix. Aim: The aim of the study was to evaluate the different risk factors of cervical cancer in persistent, progressed and regressed cases of SIL to identify the prominent ones among them. Materials and Methods: The study had been of a screening type for early detection of cervical cancer and it was done in the women population of west Lucknow, Uttar Pradesh, India (May, 2013-February, 2020). Cervical smears were collected in 2949 women attending the camps whose cytological examination revealed 498 cases of SIL and follow-up was available in 254 of them done through home visits after 1-4 years. Persistence of SIL was seen in 60 women on follow-up while in the remaining 194, the SIL had regressed to normal. The percentage of different risk factors seen with the persistence or regression of SIL was studied. Results: Among the different risk factors identified, prominent were of young age between 16-30 years with vaginal discharge and their percentage were insignificantly higher with persistence of SIL than in the regression group. Multiparity was also highly associated with both persistence and regression of SIL. The erosion of cervix was significantly associated with SIL persistence while associated inflammation was insignificantly higher in persistent than in the regression group. The percentage of all these factors except erosion of cervix was found higher in HPV- positive than in the HPV negative women. Conclusion: It appears that all the identified risk factors are present both in persistent and regression group but their percentage is higher with persistence of SIL. Hence, presence of any of these factors in these two groups should be viewed with caution to rule out any progression/recurrence of SIL.