Do Women With High-Grade Cervical Intraepithelial Neoplasia Prefer a See and Treat Option in Colposcopy?

Abstract

Women with high-grade cervical smears may be offered a defer-and-treat (DT) option in which management depends on what is found on biopsies of colposcopically suspicious areas. Alternatively, the see-and-treat (ST) option entails large loop excision of the transformation zone if the colposcopist is certain that cervical intraepithelial neoplasia-2 (CIN2) or more advanced disease is present. This prospective study, based on mailed responses to a questionnaire by 272 women with high-grade CIN who were referred for colposcopy, was intended to explore the psychological impact of these two approaches and to test the authors’ hypothesis that women prefer ST to DT. The questionnaire, which assessed the women’s perceptions and emotional reactions following their first colposcopy visit, was sent to them 1 week afterward. Women undergoing ST reported significantly fewer anxious days following their first colposcopy than those in the DT group. The ST women reported feeling significantly more relieved and, in addition, found their first visit to be more in keeping with what they had wished would happen. Women undergoing ST commented positively about the advantages of being treated at the first visit. They were pleased with not having to go on a wait list, and were gratified by not having to feel anxious while anticipating treatment. Several women in both groups found it undesirable to receive confirmation of having CIN2 or CIN3 disease. The planned next visit was missed by 14% of women having ST but only 3% of those in the DT group. Overall did-not-attend rates after 15 months were, however, very similar in both groups. Women in the ST group in this survey seemed to perceive this approach as more in keeping with their goals during the colposcopy visit. They felt more in control and were less anxious following CT. In general, women with high-grade CIN appear to benefit psychologically from the ST management strategy compared with the conventional DT approach. Nevertheless, the ST regimen does not appear to lessen the number of missed visits over the long-term.