Management of cervical dyskaryosis National guidelines are not followed

EDITOR, — We hope that the work of G Flannelly and colleagues will help bring uniformity to the management of different grades of dyskaryosis in cervical smears.1 The management of mildly dyskaryotic smears is not uniform throughout Britain. Kitchener observed in 1991 that 37% of the 210 health districts investigated had a policy of referring patients for colposcopy if a single mildly dyskaryotic smear was obtained.2 The guidelines on cervical screening produced under the auspices of the national coordinating network provide a clear strategy for the management of different grades of dyskaryosis.3

Although the national guidelines on cervical screening were widely distributed among gynaecologists, the extent to which they are followed is unknown. To investigate compliance with the national guidelines among the consultants in gynaecology and obstetrics in the north west of England a postal questionnaire survey was carried out in October 1992 by a regional working party of the Royal College of Obstetricians and Gynaecologists' audit unit. The response rate was 100%. Although, according to the national guidelines, referral for colposcopy is advisable only after two consecutive mildly dyskaryotic smears have been obtained, 13 of the 69 consultants surveyed considered a single mildly dyskaryotic smear to be an appropriate criterion for referral. Consultants who performed colposcopy themselves were more likely to consider the procedure for a single mildly dyskaryotic smear than consultants who did not perform colposcopy (11/45 (24%) v 2/24 (8%)).

A uniform strategy of referral for colposcopy for all grades of dyskaryosis would probably be welcomed by doctors working in both primary and secondary care. An easier protocol is more likely to be remembered and adhered to, but two potential problems exist. Firstly, without further allocation of resources the delay between referral and appointment to a colposcopy clinic will worsen. Secondly, with the present …