A study of the follow up patterns of women treated for CIN 2 and 3 before and after the introduction of the 1992 Guidelines

Objective To analyse the five year cytology follow up data after discharge on women treated for histologically proven cervical intraepithelial neoplas ia (CIN) 2 and 3. To assess whether the introduction of the 1992 Guidelines for Clinical Practice and Programme Management affected follow up patterns . To identify who was lost to follow up and for what reasons. Design A retrospective cohort study of cervical cytological follow up data from 186 women treated for CIN 2 and 3. Setting Primary care services, West Midlands, United Kingdom. Population One hundred and eighty-six women with CIN 2 or 3 treated with la rge loop excision of the transformation zone at the City Hospital, Birmingh am, in whom the first follow up smear at six months was normal. The women w ere divided into two groups: Group 1 consisted of women treated before the introduction of the Guidelines (1988-1990), and Group 2 consisted of women treated at the time of the introduction of the Guidelines in 1992. Intervention Introduction of the 1992 Guidelines for Clinical Practice and Programme Management. Main outcome measures To determine the number of follow up smears each woma n had over a five year period, to determine the number of women who had the recommended number of follow up smears, and to identify the number of wome n lost to follow up. Results The median (interquartile range) number of smears in Group 1 was fi ve (four to six) and in Group 2 was four (four to five). A similar proporti on of women in both groups subsequently had abnormal smears (15% and 13.6%) . Only one woman required further treatment. 22% of women in Group 1 and 10 .2% of women in Group 2 had the correct number of smears to fulfil the 1992 Guidelines. There were 21 women (11.3%) who only had one smear following d ischarge from the clinic in the five year follow up period. Conclusions The data from both cohorts shows follow up to be poor, and the introduction of the 1992 Guidelines has yet to result in an improvement in follow up patterns. The absence of a national cervical cytology database me ans that surveys of cytology follow up data will continue to be difficult d ue to the problems of data collection from numerous health authorities and the mobility of women in this age group.