Diagnosis and management of cervical abnormalities

Screening programmes identify a large number of women suspected of having a precancerous lesion of the uterine cervix, necessitating an efficient organization of diagnosis, treatment and follow-up. The ultimate criterion for the evaluation of a programme should be the long-term impact on incidence and mortality. A major problem is lack of uniformity in nomenclature, both with regard to cytology and pathology, as well as observer variation in reading and different standards. The fairly large group of women with mild and moderate atypia in cervical smears creates problems for diagnosis and management that have not been satisfactorily solved. The treatment of precancerous lesions, severe dysplasia and carcinoma in situ has been improved by the introduction of many new methods. A change is occurring from the use of hysterectomy, radiation and big cones towards more conservative methods such as colposcopy-guided biopsies, smaller cones, cryosurgery and laser treatment. This change in treatment techniques does not appear to impair the short-term results of treatment. However, a strong warning is given against using tissue-destructive methods before performing a thorough evaluation of the extent and histopathological nature of the disease. The increasingly large group of women treated for in-situ carcinoma deserves special attention and long-term follow-up, as even after treatment they still represent a high-risk group for invasive carcinoma of the uterine cervix.