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 NICE CKS.
• 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 NICE CKS.
• 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 NICE CKS.
• 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 NICE CKS,NICE CKS.
• Additional advice: Encourage smoking cessation if applicable, as smoking can impair immune clearance of HPV and increase progression risk NICE CKS. Consider HIV testing if clinically indicated, as cervical dysplasia is an HIV indicator condition NICE CKS.
• Emotional support: Offer psychological support and address any concerns about sexual function or chronic pelvic pain, referring to specialist services if needed NICE CKS,NICE CKS.

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 NICE CKS,NICE CKS,NICE CKS.