How are women with high grade Pap smear abnormalities managed? A population based study

ObjectiveThis population based study investigates the patterns of care women with high grade cervical dysplasia receive.MethodsThe study population includes women with a first time diagnosis of a high grade dysplasia (ASC-H, AGUS, HSIL, malignancy, carcinoma) from 2000 to 2005 as identified in a centralized cervical smear database. Record linkages were then carried out to other databases of health care services to characterize management.ResultsWomen (43,712) with a high grade dysplasia had a mean age of 37.6. HSIL and AGC accounted for 55% and 33% of abnormalities, respectively. The mean time to referral to colposcopy services ranged from 6 to 24 weeks. Women (1195) were diagnosed with an underlying cervical cancer with a mean time to diagnosis of 26, 26, 17, 6, and 3 weeks for the cytologic abnormality of ASC-H, AGUS, HSIL, malignancy, and carcinoma, respectively. Women (559) were diagnosed with endometrial cancer. The mean time to diagnosis from index Pap was 16, 5.3 and 1.5 weeks for AGC, malignancy, and carcinoma on Pap test, respectively. The percentage of patients with a high grade Pap smear who had no follow-up all up to a 2-year window from index Pap was 5.4, 74, 19, 1.22, and 0.18% for ASC-H, AGUS, HSIL, malignancy and carcinoma on Pap, respectively.ConclusionsThe mean time to referral to colposcopy and rates of loss to follow-up for high grade smears are influenced by cytologic nomenclature. Explicit language is recommended for national guidelines to reduce the prolonged time in the workup of patients who may have serious premalignant and malignant lesion of the reproductive tract.

Research Highlights
► Patients are waiting up to 24 weeks for referral to colposcopy services.
► The mean time to diagnosis of an underlying cervical cancer is from 3- 26 weeks.
► 25% of patients have no follow up with in 2 years of an abnormal pap smear.