Education And Debate

Controversies in Management: Immediate referral to colposcopy is safer

BMJ 1994; 309 doi: (Published 03 September 1994) Cite this as: BMJ 1994;309:591
  1. W P Soutter
  1. Royal Postgraduate Medical School, Hammersmith Hospital, London W12 0HS.

    Cervical cytological screening is effective in reducing the incidence of and mortality from cervical cancer.1 However, no screening test is perfect, and invasive squamous cancers do occur in screened women.2 As coverage of the population increases, management of mild cytological abnormalities will become more important. Currently, about 2% of all smears in England and Wales are reported to show mild dyskaryosis, although it varies among regions.3 In 1987, the intercollegiate working party on cervical cytology screening recommended immediate colposcopy for all women with dyskaryosis, where resources permitted,4 but others have subsequently suggested various formulas for cytological surveillance.

    A retrospective study in the United Kingdom in 1986 showed that 48% of women with mild dyskaryosis had cervical intraepithelial neoplasia grade II or III.5 The rate of abnormality did not depend on the number of mildly dyskaryotic smears before referral. This high prevalence of grade II or III neoplasia has been confirmed by prospective studies.*RF 6,6a* Some people have suggested that most of these lesions are small and inferred that the risk of progression to invasive disease will be less than with larger lesions.7 But there are no data to support that contention.

    Surveillance is inadequate

    Cytological surveillance is often said to allow most women with mild dyskaryosis to avoid …

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