Immediate treatment of moderate pre-cancerous cervical cells may be safely delayed without raising cancer risk

Embargoed for release until 5:00 p.m. ET on Monday 22 June 2026   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Immediate treatment of moderate pre-cancerous cervical cells may be safely delayed without raising cancer risk

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04053

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04053-PS

URL goes live when the embargo lifts             

A target trial emulation study found that of women with cervical intraepithelial neoplasia (CIN) grade 2 (CIN 2), a moderate form of pre-cancerous cervical dysplasia, excision within 6 months did not lower three-year cervical cancer risk compared to continued surveillance. Delaying treatment substantially reduced unnecessary cervical excisions. These observations suggest that it may be safe to delay treatment of CIN 2, especially lower-risk CIN 2.  The findings are published in Annals of Internal Medicine.

Because not all CIN 2 progresses to cervical cancer, appropriate management is a topic of debate. Researchers from the National Cancer Institute analyzed data from 12,012 women from the Kaiser Permanente Northern California (KPNC) cervical cancer screening program diagnosed with CIN 2 on initial biopsy between 2017 to 2023, comparing immediate treatment (excision within 6 months) with delayed management (continued surveillance or excision after 6 months). They estimated the three-year risk of unnecessary excision, CIN grade 3 or more severe, or invasive cervical cancer. Immediate treatment did not reduce three-year cancer risk but was associated with more excisions yielding less serious findings, while delayed management reduced unnecessary procedures with careful follow-up. These findings may help inform U.S. guidelines on the best management of CIN 2.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding authors Li C. Cheung, PhD and Philip E. Castle, PhD, MPH please email the NIH Press Office at nihpress@nih.gov.

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2. Multivariable screening tool outperforms PSA alone in detecting clinically significant prostate cancer

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04753

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04753-PS

URL goes live when the embargo lifts             

A population-based screening analysis found that Stockholm3, a test that combines prostate-specific antigen (PSA) levels with genetic, protein, and clinical data into a risk score, identified more clinically significant prostate cancers while missing fewer cases than standard PSA screening. The findings support the use of Stockholm3 in the context of a risk-adapted screening approach. The study is published in Annals of Internal Medicine.

Researchers from the Karolinska Institutet and colleagues conducted a secondary analysis of the baseline round of the STHLM3-MRI (Prostate Cancer Screening Using a Combination of Risk-Prediction, MRI, and Targeted Prostate Biopsies) randomized screening trial to compare detection of clinically significant prostate cancer using PSA and Stockholm3. They analyzed data from more than 12,600 men ages 50 to 74 who underwent both PSA testing and the Stockholm3 assessment. Men with abnormal results were assigned to biopsy strategies that included MRI imaging. Researchers tracked prostate cancer diagnoses over two years, focusing on clinically significant cases. They found that Stockholm3 was more sensitive than PSA alone, detecting 90% of significant cancers compared to 74% with PSA, while maintaining similar specificity. Stockholm3 also resulted in fewer missed cancers and a comparable number of unnecessary biopsies, suggesting Stockholm3 provides a more favorable balance between detection of clinically significant prostate cancer and further investigation than PSA. The findings warrant further evaluation with long-term follow-up to determine if Stockholm3 could be implemented into prostate cancer screening programs.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Thorgerdur Palsdottir, PhD please email Gwen Gordon at gwen@gwengordonpr.com.

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3. Telehealth program shows limited added benefit for diabetes control in fee-for-service setting

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00132

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01922

URL goes live when the embargo lifts             

A pragmatic trial of a nurse-led comprehensive telehealth program adapted for fee-for-service delivery did not improve blood sugar control for patients with poorly controlled type 2 diabetes compared with a simpler self-monitoring approach. The findings provide insights for decision makers considering comprehensive telehealth implementation in systems providing mainly fee-for-service care. The study is published in Annals of Internal Medicine. 

Researchers from Duke University and colleagues conducted a randomized trial of 220 patients with poorly controlled type 2 diabetes and comorbid hypertension across six academic primary care and endocrinology clinics to test whether a comprehensive telehealth program adapted for fee-for-service delivery could better manage adults with treatment-resistant chronic diseases. Participants were assigned either to a self-monitoring control program or to a nurse-led telehealth intervention that included remote monitoring, self-management support, and medication management, both lasting 12 months. At the end of the study, both groups saw reductions in blood sugar levels, but the difference was not statistically significant. The program was not delivered as consistently as planned, and challenges to fee-for-service implementation of comprehensive telehealth were identified. While comprehensive telehealth has been used effectively within certain integrated systems, the findings suggest that it did not meaningfully outperform standard self-monitoring in the studied setting. The authors note that effective interventions for treatment-resistant chronic diseases remain urgently needed.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Matthew J. Crowley, MD please email Sarah Morrison at sarah.morrison@duke.edu and Matt Talhelm at matt.talhelm@duke.edu.

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4. Antibiotic use for uncomplicated diverticulitis remains widespread despite guideline shifts

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05583

URL goes live when the embargo lifts             

A retrospective cohort study across Veterans Affairs (VA) facilities found that antibiotic prescribing rates for outpatient cases of uncomplicated diverticulitis remain above 95%, despite guidelines from 2015 recommending more selective use. The findings suggest interventions are needed to align antibiotic prescribing with current guidelines to reduce harms of unnecessary antibiotic exposure. The study is published in Annals of Internal Medicine.  

Researchers from the Minneapolis Veterans Affairs Health Care System aimed to examine how often antibiotics are prescribed for uncomplicated diverticulitis and whether practices have changed since the American Gastroenterological Association, American College of Physicians, and other professional societies recommended more selective use in 2015. Researchers analyzed more than 33,000 emergency department and urgent care visits at 120 VA facilities between October 2015 and June 2025, using electronic health records and statistical modeling to track prescribing trends. They found that antibiotics were given in 96.6% of visits overall, with little variation year to year, even as clinical guidelines advised that many patients may not benefit from routine use. The authors conclude that prescribing patterns have not meaningfully aligned with evolving recommendations and suggest that targeted interventions may be needed to reduce unnecessary antibiotic use.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Jesse D. Sutton, PharmD, MS please email jesse.sutton@va.gov.

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Also in this issue:

Early Access to GLP-1 Receptor Agonists for Weight Management in Medicare: The GLP-1 Bridge Demonstration

Sean D. Sullivan, BScPharm, PhD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01469