Colposcopists’ experiences of HPV Test of Cure for the follow up of cervical intra-epithelial neoplasia

Abstract

may be sent to s.m.sherman@keele.ac.uk. CondensationColposcopists are generally supportive of the HPV Test of Cure procedure however concerns remain regarding HPV positive cases and risk of false negative HPV results. Results: There was a 50% (N=88) response rate. 90% of respondents indicated they were happy with the new procedure. In the follow-up questions, 20% indicated they were uncomfortable with the procedure when it was applied to women who were CIN2+ with incomplete excision at the endocervical margin. Open-ended questions elicited positive aspects of TOC including reduced follow-up, increased reassurance for patients and clinicians and a faster return to the call-recall system. Negative observations included concerns around HPV positive cases, possible false negatives and anxiety in those women who were originally subject to the pre-TOC guidelines and were now returned to call-recall "earlier" than originally indicated to them. 11% of respondents also indicated they work around the new guidelines to some extent. Colposcopists' experiences of HPV Test of Conclusion:Although clinicians are on the whole positive towards the introduction of TOC , concerns were raised which centre primarily around those patients with CIN2+ combined with positive endocervical margins, issues related to HPV positive cases and the possibility of a false negative HPV result. The possibility of patient anxiety due to return to routine screening earlier than originally expected was also identified as a concern.

Risk factors for HPV persistence and cytology anomalies at follow‐up after treatment for cervical dysplasia

“…However, a recent survey of opinions on the TOC protocol among colposcopists practicing in the United Kingdom suggested that there are doubts on the use of this protocol with follow-up only at 6 months for women with positive endocervical margins and CIN2+. 24 Nevertheless, the same survey highlighted the advantages of the TOC protocol such as rapid return to the recall system and cost-savings. In the present study, there was an 81% discharge to routine recall and no cases of cancer among the study population at the routine recall cervical smear after treatment, in agreement with the Sentinel Site Study.…”

“…In the present study, there was an association between margin status and persistence of hrHPV at 6 months, but not at 3–5 years, which may support moving the TOC to 12 months for all cases except CGIN or invasive disease. However, a recent survey of opinions on the TOC protocol among colposcopists practicing in the United Kingdom suggested that there are doubts on the use of this protocol with follow‐up only at 6 months for women with positive endocervical margins and CIN2+ . Nevertheless, the same survey highlighted the advantages of the TOC protocol such as rapid return to the recall system and cost‐savings.…”

“…The mean age at the diagnosis was 33.51 years (range24-68 years, 95% confidence interval [CI] 32.24-34.77) (Table 1). The mean follow-up time was 36 months (range, 6-60 months).…”