GYNECOLOGICAL CARE OF WOMEN WITH ABNORMAL PAP SMEARS - HOW VARIED IS CURRENT PRACTICE

Objective: To assess the current management by gynaecologists of women with abnormal Papanicolaou (Pap) smears. Design: Self-administered su rvey of all gynaecologists registered in New South Wales. Results: 242 gynaecologists (73% response rate) returned completed questionnaires. Accredited laboratories were used by 90% of gynaecologists, but only 61% could confirm their laboratories' participation in quality assuran ce procedures. Consensus on the management of high grade Pap smear abn ormalities was confirmed. In contrast, there was considerable variatio n in the management of minor lesions, provision of patient information and follow-up after treatment. A small but worrying minority of respo ndents indicated an apparent misunderstanding of important colposcopic principles: 41% were prepared to institute ablative therapy without h istological diagnosis. Conclusions: Given the nature of practice varia tion documented in this survey, publication of national guidelines is necessary to improve the screening program. Guidelines in themselves, however, will not be sufficient to ensure that all women with abnormal results of Pap smears receive appropriate and timely management and f ollow-up. Active dissemination to reduce undesirable variation is requ ired.