THE ADEQUACY OF MANAGEMENT OF WOMEN WITH CIN 2 AND CIN 3 PAP SMEAR ABNORMALITIES

Objective: To assess the adequacy of management of Sydney women with P apanicolaou (Pap) smears showing cervical intraepithelial neoplasia (C IN) grades two and three. Design: A prospective descriptive study of p atient management. Method. All 206 general practitioners (GPs) who sen t Pap smears which were reported as CIN 2 or CIN 3 to three Sydney lab oratories between January and June 1990 were included in the sample. T he GPs were contacted and management details for the women collected. The adequacy of management was evaluated by comparing it with manageme nt guidelines constructed for the study. Management steps were: notifi cation of results, referral for colposcopy, biopsy, treatment and foll ow-up. The number of women reaching each step, expressed as a proporti on of those women who should have reached that step according to the m anagement guidelines, was calculated. The points where management was inadequate were established and the reasons explored. Results: All GPs provided management information about their patients. Ninety-nine per cent of women (95% confidence intervals [CI], 98%-100%) were informed of their Pap smear result and 94% (CI, 90%-97%) of the total sample s ubsequently underwent colposcopy. Ninety-three per cent (CI, 88%-97%) of the 160 women definitely requiring histological diagnosis had this and 98% (CI, 94%-100%) of the 140 women definitely needing treatment w ere treated. Following treatment (or equivalent if not indicated) 80% of women (CI, 74%-86%) were known to have had a follow-up Pap smear bu t only 31% (CI, 24-38%) of women needing follow-up colposcopy were kno wn to have had it. At the time of the study (on average, 17 months aft er the index Pap smear) only 60% (CI, 54%-67%) of women were still bei ng followed up. Conclusions: Virtually all women with the more severe cytological abnormalities are being referred by their GPs for further investigation and treatment. However, follow-up after treatment is oft en inadequate. The responsibility for this follow-up needs to be clari fied, as well as communication about it between women, their GPs and g ynaecologists. A cytology registry could increase the proportion of Sy dney women known to be receiving follow-up.