The management of women with initial minor Pap smear abnormalities

To describe the management and follow-up of women with initial minor Papanicolaou (Pap) smear abnormalities by general practitioners (GPs) in metropolitan Sydney in 1990.

One hundred women with cervical intraepithelial neoplasia grade 1 (CIN 1) and 121 women with mild squamous atypia (MSA) on Pap smears taken by GPs in 1990, who had not had Pap smear abnormalities in the previous two years, were sampled from the records of four Sydney pathology laboratories.

A descriptive study. Information about the management of women after their Pap smear was obtained from GPs by telephone questionnaire.

Of women with MSA, 19% were initially investigated by colposcopy, and 8% went on to have treatment. Of 82 women with MSA who were not initially investigated, 80% had follow-up Pap smears within 12 months. Of women with CIN 1, 84 underwent colposcopy with or without biopsy; 27% of these women had CIN 2/3 and 31% had CIN 1 confirmed by investigation. Overall, 51% of women with CIN 1 on their initial Pap smears were treated by excisional or ablative means, including 78% of women with confirmed CIN 2/3, and 69% of women with confirmed CIN 1. Two and a half years after the original Pap smear, only 46% of women with initial MSA and 51% of women with initial CIN 1 were known by their GP to be having follow-up.

Most women with MSA were managed by initial observation, and those with CIN 1 were managed by initial investigation. However, the range of management practices described suggests a lack of consensus among practitioners about the most appropriate management for women with minor cervical abnormalities. A large randomised controlled trial would help elucidate preferred management guidelines. The difficulty individual GPs experience in following up women after abnormal Pap smears supports the establishment of centralised State cytology registers.