Colposcopy and treatment of cervical intra-epithelial neoplasia: are national standards achievable?

Abstract

Objective: To assess whether consensus based national standards for colposcopy and treatment of cervical intra-epithelial neoplasia are achievable in practice.

Design: Identification of 100 consecutive cases of first assessment colposcopy from each gynaecological unit in the former North West region from 1 January 1994 and follow up of their outcome after one year.

Setting: All 19 gynaecological colposcopy clinics in the former North West region.

Sample: In one hospital data were available on only 39 women and therefore information was analysed on 1839 women.

Main outcome measures: Waiting times for colposcopy, different modalities of treatment used for premalignant conditions of the cervix and type of anaesthesia used for treatments. With regard to follow up, time of occurrence, whether or not colposcopy was performed and efficacy of treatment as judged by cervical cytology.

Results: Waiting times for colposcopy varied in the individual hospitals studied, but overall 56% of patients were seen within eight weeks. Diathermy loop excision was the most popular treatment modality accounting for 44% of cases. At six months after treatment, 9.98% of patients had a smear of mild dyskaryosis or worse. Colposcopy, as well as cytology, was used at the first follow up visit in 43% of cases.

Conclusion: At a local level individual hospitals can identify areas where improvements in the service they provide need to be made. The practicality of the current guidelines in today's health service needs questioning.