Controversy in Colposcopic Management: A Canadian Survey

Abstract

ObjectiveThe substantial reduction in cervical cancer mortality over the last 40 years is attributed to the use of Papanicolaou cervical smear screening with subsequent colposcopic assessment and treatment. Although there is consensus regarding colposcopic management of high-grade intraepithelial cervical lesions, optimal management of patients with low-grade (LG) lesions is less clear. Our goal was to document the colposcopic management of the latter group in Canada. MethodsA survey was mailed to 252 colposcopists in seven Canadian provinces who recommended management for colposcopy scenarios. Responses were reported in aggregate form. ResultsA total of 120/252 (48%) completed questionnaires. Most respondents were 41 to 50 years old, and 68% were male. For women found on colposcopy to have no evidence of a low-grade cervical LG lesion, 43% recommended discharge from colposcopy, and 53% recommended repeat colposcopy. For referrals with a biopsy-confirmed LG lesion, 13% recommended discharge to cytological follow-up, 65% recommended repeat colposcopy, and 16% recommended treatment. Following excisional treatment of LG lesions with negative margins, 13% recommended discharge to cytological follow-up, and 69% recommended further colposcopy. ConclusionThese results demonstrate wide variation in management of low-grade cervical lesions among Canadian colposcopists and highlight the need to establish evidence-based management protocols.