An alternative approach to the management dilemma of the mildly dyskaryotic smear based on audit of outcome

We describe a study which takes an alternative approach to the management d ilemma of the mildly dyskaryotic cervical smear. Two hundred and fifty wome n with a smear showing mild dyskaryosis were studied by auditing the clinic al outcome as well as the cost. The cost of providing the colposcopy servic es during the index year was approximately pound 70 000 for an average size district general Hospital. The proportion of women managed by the current guidelines and avoiding colposcopy after a first mildly dyskaryotic smear w as only 30%. The majority of patients will eventually have colposcopy despi te a policy of cytological surveillance. The alternative approach, to offer colposcopy immediately after the first mildly dyskaryotic smear, would res ult in a small increase in cost for our unit, equivalent to one extra colpo scopy patient per week.