Gynaecological care of women with abnormal Pap smears: how varied is current practice?

To assess the current management by gynaecologists of women with abnormal Papanicolaou (Pap) smears.

Self-administered survey of all gynaecologists registered in New South Wales.

242 gynaecologists (73% response rate) returned completed questionnaires. Accredited laboratories were used by 90% of gynaecologists, but only 61% could confirm their laboratories' participation in quality assurance procedures. Consensus on the management of high grade Pap smear abnormalities was confirmed. In contrast, there was considerable variation in the management of minor lesions, provision of patient information and follow-up after treatment. A small but worrying minority of respondents indicated an apparent misunderstanding of important colposcopic principles: 41% were prepared to institute ablative therapy without histological diagnosis.

Given the nature of practice variation documented in this survey, publication of national guidelines is necessary to improve the screening program. Guidelines in themselves, however, will not be sufficient to ensure that all women with abnormal results of Pap smears receive appropriate and timely management and follow-up. Active dissemination to reduce undesirable variation is required.