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Management guidelines for women with normal colposcopy after low grade cervical abnormalities: population study
G R Teale1, D D Moffitt, C H Mann
1Birmingham Women's NHS Trust, Edgbaston, Birmingham B15 2TG. glynteale@compuserve.com
Objectives:
To develop an evidence based protocol for the follow up of women with low grade cervical abnormalities for whom treatment is not immediately indicated.
Design:
Population outcome study.
Setting:
Colposcopy clinic of an inner city teaching hospital.
Participants:
566 women with low grade cytological abnormalities who were not treated at a first visit to the colposcopy clinic, followed up for a total of 881 years.
Main Outcome Measures:
Resolution of abnormalities, persistence of disease, and treated disease.
Results:
Abnormalities resolved in 306 (54.1%) women, whereas 138 (24.4%) had persistent disease and 122 (21.5%) were subsequently treated. Colposcopic opinion, smear test results, age, smoking history, and number of pregnancies were all significantly related to outcome. Logistic regression analysis produced a model that correctly identified 70% of women whose abnormalities resolved. Only 23 of 295 women (7.8%) with a normal cervix on colposcopy and a smear without dyskaryosis at a first visit were treated by the end of the observation period.
Conclusions:
Women referred with low grade cytological abnormalities who have a normal cervix on colposcopy and a negative or borderline repeat smear test result may be discharged from the colposcopy clinic. We propose a follow up protocol that could safely avoid unnecessary visits to a clinic.