Management choice and adherence to follow-up after colposcopy in women with cervical intraepithelial neoplasia 1

OBJECTIVE: To determine women's preference when given a choice of managemen t between cryotherapy and cytology surveillance and to compare subsequent a dherence to serial cytologic follow-up after being diagnosed with cervical intraepithelial neoplasia grade 1 (CIN1). METHODS: Two hundred nineteen low-income women with biopsy-proven CIN1 seen in a reproductive health clinic from August 1995 through December 1999 wer e offered cryotherapy or cytology surveillance, followed by cytologic testi ng every 4 months until three consecutive results were normal. Endpoints of the study were: successful completion of follow-up; transferred or referre d out of clinic; or lost to follow-up. RESULTS. Ninety-four women (42.9%) those cryotherapy, compared with 125 wom en (57.1%) who chose cytology surveillance (P < .05). Cryotherapy patients were more likely to return for at least one visit (their treatment visit) a fter colposcopy compared with cytology surveillance patients (P < .001). In contrast to their initial return for treatment of 98.9%, cryotherapy patie nts were less likely to return for their first follow-up cytology visit com pared to surveillance-only patients (68.1% and 83.2%, respectively, P < .01 ). Thirty-seven percent of the total group successfully completed follow-up at the clinic, 30.1% transferred or were referred, and 32.9% were lost to follow-up. CONCLUSION: Successful completion of a commonly recommended protocol for se rial cytology follow-up was low. Management choice affected initial adheren ce but not adherence to long-term follow-up. (C) 2001 by the American Colle ge of Obstetricians and Gynecologists.)