Education And Debate

Invasive cancer of the cervix in women with mild dyskaryosis followed up cytologically

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6941.1421 (Published 28 May 1994) Cite this as: BMJ 1994;308:1421
  1. W P Soutter,
  2. A Fletcher
  1. Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, London W12 0NN Department of Epidemiology and Population Studies, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
  • Accepted 6 May 1994

Mildly dyskaryotic smears are common, and women with such results are often followed up with further cervical smear tests. An important consideration in evaluating this practice would be the annual incidence of invasive cervical cancer. A reanalysis of five previous studies of the cytological follow up of women with mildly abnormal smear test results was undertaken to calculate this incidence. The annual incidence of invasive cancer in these women ranged from 0 to 420 per 100 000 women years. The large studies providing the most precise estimates had annual rates of 143 to 420 per 100 000 women years. This is 16 to 47 times greater than in women aged 15-34 years in England and Wales. The average rate was 208 per 100 000 women years. Women with mild dyskaryosis are at high risk of developing invasive cervical cancer despite cytological follow up. A full appraisal of the costs and benefits of colposcopy in this situation is urgently required.

Introduction

From a survey of several cytology laboratories in England and Wales it is estimated that mild dyskaryosis is reported in just over 2% of all the samples taken in the United Kingdom.1 The management protocol for women with such abnormalities will have a substantial impact on the cost and effectiveness of the cervical screening programme. Some successful programmes in other countries have managed such women with repeated cervical smear tests,2,3 but cytology is not a precise science and cross sectional, retrospective,4,5 and prospective6,7 colposcopic studies have shown that mild dyskaryosis is associated with a high prevalence of cervical intraepithelial neoplasia stage III. These data have led some to recommend that all women with mild dyskaryosis should be referred for colposcopy after the first such result.8

Others, reporting the results of retrospective studies of the cytological surveillance …

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