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In the UK and Europe it is managed across multiple specialties with differing strategies, creating inconsistent diagnosis and treatment and disadvantaging affected people. Screening for anogenital precancers is largely sporadic, with cervical exceptions. This article defines the MZIN terminology and scope, aligning stakeholders to support a framework for national UK guidelines and future international work on screening, diagnosis, and treatment.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/multizonal-intraepithelial-neoplasia-of-the-lower-genital-tract-and-anus-in-women-terminology-for-defining-the-disease-an-introduction/370065/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/multizonal-intraepithelial-neoplasia-of-the-lower-genital-tract-and-anus-in-women-terminology-for-defining-the-disease-an-introduction/370065.png","ImageObject",300,407,{"name":92,"@type":93},"hdkawk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is multizonal anogenital intraepithelial neoplasia (MZIN)?","Question",{"text":112,"@type":113},"MZIN is defined as HPV-related squamous intraepithelial lesions occurring in two or more anogenital regions (zones).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the article emphasize standardised terminology and guidelines?",{"text":117,"@type":113},"Differing clinical strategies across specialties lead to lack of standardisation in diagnosis and treatment, and screening is often sporadic in the UK and Europe, except for the cervix.",{"name":119,"@type":110,"acceptedAnswer":120},"Who is the target group for tailored monitoring and what care actions are suggested?",{"text":121,"@type":113},"People with MZIN are a high-risk group for anogenital cancers and may require tailored monitoring in specialist multi-disciplinary clinics, with centralisation of care and education for primary providers.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},370065,1790661715,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","British Journal of Cancer [www.nature.com/bjc](www.nature.com/bjc)  \nPERSPECTIVE Epidemiology  \nOPEN  \nMultizonal intraepithelial neoplasia of the lower genital tract and anus in women: terminology for defining the disease, an introduction by the British Society for Colposcopy and Cervical Pathology (BSCCP), International Anal Neoplasia Society (IANS), European Federation for Colposcopy (EFC) and British Society for the Study of Vulval Disease (BSSVD) scientific committees  \nSarah J. Bowden 1,2, Laura Burney Ellis1,2, Tamzin Cuming3,4, Danielle Brogden5, Susan M. Sherman6, David A. Finch7, Shaun Haran2, Julie Bowring3, George Mochloulis8, Alice M. Schofield9, Archie Krishna10, Andrew G. Renehan 7,11, Maggie E. Cruickshank12, Pierre Martin-Hirsch 13, Maria Kyrgiou 1,2 ✉ , Deirdre Lyons2 and Theresa Freeman-Wang14  \n© The Author(s) 2025  \n\n|  | Multizonal anogenital intraepithelial neoplasia (MZIN) is an uncommon chronic pre-malignant condition. In the United Kingdom (UK) and elsewhere MZIN is managed by a variety of clinical specialities with differing strategies, resulting in a lack of standardisation in diagnosis and treatment which ultimately disadvantages those affected. Screening for anogenital precancerous conditions is sporadic rather than nationalised in the UK and elsewhere in Europe, with the exception of the cervix. To address this lack of standardisation, the BSCCP brought together a panel of stakeholders from aligned expert society committees (IANS, EFC and BSSVD) to review existing evidence and provide a framework for national UK guidelines. Here, we define terminology and scope, asa platform for subsequent guideline development and guide further research. We define MZIN as Human Papillomavirus (HPV) -related squamous intraepithelial lesions occurring in two or more anogenital regions. People with MZIN are a high-risk group for anogenital cancers and subsequently may require tailored monitoring in specialist multi-disciplinary clinics. Centralisation of care and education for primary care providers may improve management. The development of guidelines which incorporate all clinical stakeholders are now needed to provide an international framework regarding the screening, diagnosis, treatment and future |  |\n| --- | --- | --- |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n| prevention of MZIN. |  |  |\n|  | British Journal of Cancer (2026) 134:177–184; [https://doi.org/10.1038/s41416-025-03259-z](https://doi.org/10.1038/s41416-025-03259-z) |  |\n|  |  |  |\n\nINTRODUCTION  \nPeople with persistent high-risk (oncogenic) human papillomavirus (HPV) infection are at increased risk of high-grade squamousintraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) of the anogenital region. The lower anogenital squamous terminology (LAST) consensus recommends that squamous intraepithelial lesions are defined as low-grade (LSIL) and high-grade (HSIL) of allanogenital sites [1] . This terminology is widely implemented by  \nAmerican societies. In many European countries, intraepithelial neoplasia (-IN, with an accompanying grade) is the most commonly used term for describing pre-malignant lesions of the anogenital region. Multizonal describes disease in multiple (two or more) zones,  \nwhere a zone represents a distinct anatomical anogenital site.  \nTreatment of cervical, vulval and vaginal high-grade intraepithelial neoplasia (equivalent to HSIL) to prevent cancer is well established in gynaecological practice. Recently, the treatment of  \n1Institute of Reproductive and Developmental Biology, Department Digestion, Metabolism, & Reproduction – Surgery & Cancer, Imperial College London, London, UK. 2Imperial College NHS Trust, London, UK. 3Homerton Anogenital Neoplasia Service, Homerton University Hospital London, London, UK. 4Surgery & Cancer, Imperial College London, London, UK. 5Department of Colorectal Surgery. Maidstone and Tunbridge Wells NHS Trust, Tun","cbCaihrYsYsJspM8","https://ap.wps.com/l/cbCaihrYsYsJspM8","pdf",646308,"English","# Introduction\n## Background and rationale for terminology standardisation\n## Definition of MZIN and clinical implications\n## Care centralisation and need for guidelines","[{\"question\":\"What is multizonal anogenital intraepithelial neoplasia (MZIN)?\",\"answer\":\"MZIN is defined as HPV-related squamous intraepithelial lesions occurring in two or more anogenital regions (zones).\"},{\"question\":\"Why does the article emphasize standardised terminology and guidelines?\",\"answer\":\"Differing clinical strategies across specialties lead to lack of standardisation in diagnosis and treatment, and screening is often sporadic in the UK and Europe, except for the cervix.\"},{\"question\":\"Who is the target group for tailored monitoring and what care actions are suggested?\",\"answer\":\"People with MZIN are a high-risk group for anogenital cancers and may require tailored monitoring in specialist multi-disciplinary clinics, with centralisation of care and education for primary providers.\"}]","Multizonal intraepithelial neoplasia of the lower genital tract and anus in women - terminology for defining the disease - an introduction | PDF",1790186559]