Controversies in Management: Management of women with mild dyskaryosis Cytological surveillance avoids overtreatment

The smear report is undoubtedly the most important variable when deciding whether a woman should be referred for colposcopy. National guidelines on referral for colposcopy also need to consider the scientific data, the availability of facilities locally, and the psychological impact of referral and treatment. The psychological sequelae of referral for colposcopy, with possible treatment, may be greater than the risk of serious disease developing from the abnormality that the smear identified. National experts recently reached a consensus that recommends immediate referral for colposcopy for women with more severe cytological abnormalities and repeat cervical smear tests for those women with macroscopically normal cervices and smears showing mild dyskaryosis or borderline nuclear changes. If smear tests continue to show cytological abnormality the woman is then referred for colposcopy.1

In the United Kingdom 5.5 million smear tests are performed annually, of which 2.4% show mild dyskaryosis and 2.2% are reported as showing borderline nuclear abnormalities. In younger women the proportion with borderline or mild changes is about 7.7%. This represents over 250 000 smears reported to show minor cytological abnormalities each year. Though the figures are not directly comparable, this can be related to the fact that about 350 000 girls are born each year in Britain but there are fewer than 1900 deaths a year from cervical cancer, many in women who never had a cervical …