How should I counsel a patient who has received a diagnosis of CIN 2 regarding the risks and management options?

Counselling a patient diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) should include the following key points:

• Explain the nature of CIN2: CIN2 represents abnormal cellular changes affecting about two-thirds of the thickness of the cervical surface layer and is considered a high-grade lesion that correlates with cervical precancer. If left untreated, CIN2 lesions may progress to cervical cancer, so they require careful management ¹.
• Discuss the associated risks: Patients treated for CIN2 are 2–5 times more likely than the general population to develop cervical cancer, emphasizing the importance of adherence to follow-up protocols ¹.
• Management options: The standard management usually involves treatment by excisional procedures such as loop electrosurgical excision (LLETZ) or conization aiming to completely remove the abnormal cells and achieve clear margins ³.
• Follow-up and surveillance: After treatment, patients should have a test of cure with repeat cervical sampling 6 months post-treatment. If the test is negative for high-risk human papillomavirus (hrHPV), they can return to routine screening. If hrHPV positive, further colposcopy is indicated ¹,².
• Additional advice: Encourage smoking cessation if applicable, as smoking can impair immune clearance of HPV and increase progression risk ². Consider HIV testing if clinically indicated, as cervical dysplasia is an HIV indicator condition ².
• Emotional support: Offer psychological support and address any concerns about sexual function or chronic pelvic pain, referring to specialist services if needed ²,³.

Summary: Inform the patient that CIN2 is a precancerous condition requiring treatment and close follow-up to prevent progression to cervical cancer. Treatment is usually excisional, followed by HPV testing and cytology to ensure clearance. Adherence to follow-up is critical to reduce cancer risk ¹,²,³.