Management guidelines for women with normal colposcopy after low grade cervical abnormalities: population study

Objectives To develop an evidence based protocol for the follow up of women with low grade cervical abnormalities for whom treatment is not immediatel y indicated. Design Population outcome study. Setting Colposcopy clinic of an inner city teaching hospital. Participants 566 women with low grade cytological abnormalities who were no t treated at a first visit to the colposcopy clinic, followed up for a tota l of 881 years. Main outcome measures Resolution of abnormalities, persistence of disease, and treated disease. Results Abnormalities resolved in 306 (54.1%) women, whereas 138 (24.4%,) h ad persistent disease and 122 (21.5%) were subsequently treated. Colposcopi c opinion, smear test results, as, smoking history, and number of pregnanci es were all significantly related to outcome. Logistic regression analysis produced a model that correctly identified 70% of women whose abnormalities resolved. Only 23 of 295 women (7.8%) with a normal cervix on colposcopy a nd a smear without dyskaryosis at a first visit were treated by the end of the observation period. Conclusions Women referred with low gr-ade cytological abnormalities who ha ve a normal cervix on colposcopy and a negative or borderline repeat smear test result may be discharged from the colposcopy clinic. We propose a foll ow up protocol that could safely avoid unnecessary visits to a clinic.