Long‐term compliance with follow‐up after treatment for cervical intra‐epithelial neoplasia

Soutter, W. P.; Moss, Bronwen; Perryman, Karen; Kyrgiou, Maria; Papakonstantinou, Katerina; Ghaem‐Maghami, Sadaf

doi:10.1111/j.1600-0412.2012.01477.x

Cited by 18 publications

(19 citation statements)

References 18 publications

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“…Several authorities recommend conservative surveillance in the primary care setting, as spontaneous regression of most of these lesions will occur and there is a risk of over‐intervention . The opponents supporting immediate colposcopy emphasize that protracted attendance for repeat cytology decreases with time and this was also confirmed in this analysis. One third of women referred with borderline or low‐grade cytological abnormalities have an occult high‐grade disease and non‐compliance may put them at risk of invasive disease .…”

Section: Discussionsupporting

confidence: 60%

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Kyrgiou

Kalliala

Mitra

et al. 2016

Intl Journal of Cancer

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We performed a systematic review and meta-analysis to explore the optimum management strategy for women with atypical squamous cells of undetermined significance (ASCUS/borderline) or low-grade squamous intra-epithelial lesions (LSIL/mild dyskaryosis) cytological abnormalities at primary screening in the absence of HPV DNA test. We searched MEDLINE, EMBASE and CENTRAL and included randomised controlled trials comparing immediate colposcopy to cytological surveillance in women with ASCUS/LSIL. The outcomes of interest were occurrence of different histological grades of cervical intraepithelial neoplasia (CIN) and default rates during follow-up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect model and with inverse variance weighting. Interstudy heterogeneity was assessed using I 2 statistics. Six RCTs were included. Immediate colposcopy significantly increased detection of unimportant abnormalities as opposed to repeat cytology (koilocytosis: 32 vs. 21%, RR: 1.49, 95% CI 5 1.17-1.90); CIN1: 21 vs. 8%, RR: 2.58, 95% CI 5 1.69-3.94). Although immediate colposcopy detected CIN2, CIN21, and CIN31 earlier than cytology, the differences were no longer observed at 24 months (CIN31: 10.3 vs.11.9%, RR: 1.02, 95% CI 5 0.53-1.97), with significant interstudy heterogeneity (p < 0.001, I 2 5 93%). Default risk was significantly higher for repeat cytology (6 months: 6.3 vs. 13.3%, RR: 3.85, 95% CI 5 1.27-11.63; 12 months: 6.3 vs. 14.8%, RR: 6.39, 95% CI 5 1. 24 months: 0.9 vs. 16.1%, RR: 19.1,. Detection of CIN21 for cytological surveillance over two years is similar to that of immediate colposcopy, although patients may default. Colposcopy may be first choice when good compliance is not assured, but may increase detection of insignificant lesions. This emphasizes the need for a reflex triage test to distinguish women who need diagnostic work-up from those who can return to routine recall.

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Section: Discussionsupporting

confidence: 60%

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Kyrgiou

Kalliala

Mitra

et al. 2016

Intl Journal of Cancer

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“…293-297), something we have repeatedly published on in past years (2,3,4). We also find the halving of perinatal mortality (mainly from stillbirths) in placental abruption shown in a large epidemiological study from Finland (Minna Tikkanen and coworkers, Helsinki and Tampere) of real interest.…”

supporting

confidence: 58%

“…Most of those having bariatric surgery are women, often of reproductive age and therefore their situation merits specific attention in our overindulgent and overweight era.Enrique Coppolillo and co-workers in Buenos Aires, Argentina, do again point to the need for careful followup of women who present with cytologic changes of a substatial nature in pregnancy (pp. 293-297), something we have repeatedly published on in past years (2,3,4). We also find the halving of perinatal mortality (mainly from stillbirths) in placental abruption shown in a large epidemiological study from Finland (Minna Tikkanen and coworkers, Helsinki and Tampere) of real interest.…”

supporting

confidence: 58%

Assessing, teaching and defining: issues in obstetrics and gynecology

Nisell¹,

Geirsson²

2013

Acta Obstet Gynecol Scand

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The March issue contents are varied and of good quality. There is a meta-analysis from Louise Baandrup and colleagues in Copenhagen, on the commonly used NSAID drugs and ovarian cancer risks. Research at the Danish Cancer Society has a world-wide reputation and can be considered as authoritative when it comes to both their own epidemiological data-evaluation and reasoned opinions done in a scientifically good fashion. Even if not conclusive, the study is helpful for showing where emphasis must be placed for adding to current knowledge in one of the more difficult fields of our speciality; ovarian cancer management. The discussion is clear on what problems must be overcome when common over-the-counter drugs need to be evaluated in relation to well defined disease entities.Cesarean section is one of the first operations that a trainee in this speciality has to learn and indeed wants to learn fast for the glory of it. Most of us have historically acquired our skills initially on a teacher-apprentice basis where personal preferences of the senior may have weighed more than securely based evidence. Even the now "fashionable" guidelines may differ on what one is recommended to do. Kristine Madsen and colleagues in Copenhagen and Hiller€ od, Denmark, discuss the training for cesarean section on pp. 256-263. When they suggest international training programs in the last part of their discussion, then such educational strategies are an obvious task to address within our inter-Nordic collaboration efforts. We, the authors of this months Editors Message, know of course exactly how a cesarean section should be done, from start to finish, but who is to say that our individual and probably not quite uniform methods are each the best? One thing is certain: it should not be us. Operative procedures evolve and need scientific scrutiny, not least the common ones. That also applies to bariatric surgery, which Mette Kjaer and Lisbeth Nilas, also from Copenhagen, consider in relation to pregnancy on pp. 264-271. That a post-procedure pregnancy can be fatal was recently shown in this journal (1). So far much of the evidence presented on bariatric surgery and pregnancy is in the form of small case series, but in this prospective data-gathering is essential. Most of those having bariatric surgery are women, often of reproductive age and therefore their situation merits specific attention in our overindulgent and overweight era.Enrique Coppolillo and co-workers in Buenos Aires, Argentina, do again point to the need for careful followup of women who present with cytologic changes of a substatial nature in pregnancy (pp. 293-297), something we have repeatedly published on in past years (2,3,4). We also find the halving of perinatal mortality (mainly from stillbirths) in placental abruption shown in a large epidemiological study from Finland (Minna Tikkanen and coworkers, Helsinki and Tampere) of real interest. This shows what still can be achieved in part through changing population characteristics (decrease in smoking) and service provis...

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“…185–192). Adequate screening programs aimed at younger women to find cervical cell changes in time and adequate follow‐up is vital, even if HPV triaging is introduced and after HPV vaccination will start to affect population rates . Lower attendance for cervical smears within the organised screening in recent years is a concern in many countries.…”

mentioning

confidence: 99%

Women in the limelight: a varied issue

Geirsson¹

2013

Acta Obstet Gynecol Scand

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Long‐term compliance with follow‐up after treatment for cervical intra‐epithelial neoplasia

Cited by 18 publications

References 18 publications

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Assessing, teaching and defining: issues in obstetrics and gynecology

Women in the limelight: a varied issue

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