[ASC-US Pap Smear follow-up in a French department in 2077]

In the event of an ASC-US Pap smear, colposcopy, 6-month Pap smear or screening for oncogenic HPV are recommended as first-line testing options by the French National Authority for Health -HAS. The primary objective of this study was to determine the preferred option chosen by general practitioners and to assess their follow-up care.

The Maine-et-Loire cancer screening database was used to extract 283 files of women, aged 25 to 65, in whom ASC-US Pap smear was performed by their general practitioners (GPs) in 2011.

265 women (93.6%) underwent their first test (C1]. GPs performed 64.5% of tests: 93% of which were Pap smears, 5.3% were HPV tests and 1.7% were Pap smears combined with HPV tests. 164 patients (58%) received comprehensive follow-up, i.e 2 tests after the first ASC-US pap smear or a therapeutic intervention after an abnormal Cl. 14 patients were lost to follow-up. Follow-up rate was 57.6% in the case of a normal C1 and 83.3% in the case of an abnormal C1. 79.2% of first tests were normal and a total of 16 high-grade lesions were diagnosed (5.7%).

The fact that liquid-based Pap smears were rarely used might explain why HPV testing is rarely prescribed. The rarity of ASC-US anomalies, the variable potential for progression and the possibility to choose between several follow-up options proved to be obstacles for GPs to apply guidelines. The poor coordination . between gynaecologists and GPs, the difficulties in planning follow-up and the lack of precision of test reports may limit the efficacy of monitoring.