Diagnosis and treatment of cervical intraepithelial neoplasia in general practice

Abstract

Objective - To audit the first five years of a colposcopy and treatment service for cervical dysplasia established within a general practice. Design - A cervical smear register was established to determine which women were 'at risk' of dysplasia. The results of colposcopy and treatment of dysplasia were analysed. Setting - A large rural general practice with community hospital facilities in mid-Wales. Patients - 4437 Women at risk in a total practice population of 14,100. Interventions - Colposcopy of women with dyskaryotic smear results, persistent inflammatory smear results, or vulval warts. Treatment of women with proved dysplasia by electrodiathermy of the cervix or cone biopsy. Results - 138 Women with dysplasia were diagnosed over five years: 36 mild, 97 moderate or severe, and five with microinvasion. Despite a 78% smear rate of at risk women over five years, nine invasive cancers still occurred. Conclusions - The results of treatment are acceptable. Cervical dysplasia has become very common, the risk of a dysplasia in women aged 20-39 who had smear tests being one in 14 over five years.