Controversies in Management: Immediate referral to colposcopy is safer

Soutter, W. P.

doi:10.1136/bmj.309.6954.591

Cited by 16 publications

(2 citation statements)

References 11 publications

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“…Previous smears were equally likely to be negative or mildly abnormal. This finding is consistent with the relative poor sensitivity of an individual smear; and with the well recognized fact that minor cytological abnormalities may indicate higher degrees of CIN and may progress to higher grade CIN within a few years 36 , 37 . The percentage of cases of CIN III preceded by mild dyskaryosis in the present study is similar to that reported by Flannelly et al 38 …”

Section: Discussionsupporting

confidence: 92%

Cervical intraepithelial neoplasia grade III (CIN III) and invasive cervical carcinoma: the yawning gap revisited and the treatment of risk

Herbert

Smith

1999

Cytopathology

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In a 3-year study of the population of Southampton and south-west Hampshire there were 10 times as many cases of CIN III compared with invasive squamous carcinoma (700 compared with 70). The peak incidence of CIN III per 1000 screened women years was in those aged 25-29 years, which was 20 years earlier than the peak incidence of invasive cervical cancer per 1000 women years at risk. Ninety percent of CIN III was diagnosed in women under 50 years. There were 14 cases of cervical glandular intraepithelial neoplasia grade III (CGIN III), three coexisting with CIN III, all in women aged under 50 years: the gap between intraepithelial and invasive lesions was not seen for glandular neoplasia. Although referral was for at least moderate dyskaryosis in 86.8% of women with CIN III or CGIN III, most had been screened previously, either having had mild abnormalities requiring repeat cytology (39.8%) or negative cytology (34.5%). Only 12 women aged > or = 50 years had previous negative cytology: 21.4% compared with 35.6% of women aged < 50 years (P = 0.034). The results of this study suggest that the best opportunity for preventing invasive squamous cell carcinoma lies in screening women aged 20-39 years when the incidence of CIN III in the screened population is highest and before the peak incidence of invasive disease. The results also indicate the importance of repeated screening and follow up of minor cytological abnormalities in the detection of CIN III. The benefit of screening must be regarded as a treatment of risk, since it is almost certain that a high proportion of CIN III regresses or persists unchanged.

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Section: Discussionsupporting

confidence: 92%

Cervical intraepithelial neoplasia grade III (CIN III) and invasive cervical carcinoma: the yawning gap revisited and the treatment of risk

Herbert

Smith

1999

Cytopathology

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“…Robertson et al evaluated all Paps up to 18 years preceding the cervical cancer diagnosis in 62 women; only one had an LGSIL Pap [39]. A retrospective study in the United Kingdom of women with mild dyskaryosis, followed by cytologic surveillance, showed risks of subsequent cervical cancer ranged from 16‐ to 47‐fold compared with the 9/ 100,000 overall incidence in this group [41–43]. That these women were mainly in the 15–34 years‐old age group is even more disconcerting.…”

Section: Options For the Management Of Lgsilmentioning

confidence: 99%