P‐16 DEFAULT FROM CYTOLOGICAL SURVEILLANCE OF LOW‐GRADE SMEARS: LEVELS OF DEFAULT AND CHARACTERISTICS OF DEFAULTERS IN THE TRIAL OF MANAGEMENT OF BORDERLINE AND OTHER LOW‐GRADE ABNORMAL SMEARS (TOMBOLA)

Abstract

Introduction: We report levels of default in women with low‐grade cytological abnormalities managed by cytological surveillance and identify factors associated with default.Method: TOMBOLA is an RCT comparing cytological surveillance (repeat smears every 6 months in primary care) with hospital‐based colposcopy in women with a low‐grade smear. TOMBOLA recruits were aged 20–59, with a recent mild or borderline smear, plus up to one previous borderline smear, detected within the NHS‐CSPs. This analysis includes 2224 women randomised to cytological surveillance. Default was defined as non‐attendance within 6 months of each surveillance smear being due.Results: 11% (95% CI 9.3–12.0) of women defaulted from the first surveillance smear. 13% (11.0–14.1) of those having a first surveillance smear defaulted from the second. 14% (12.1–15.5) of those having a second surveillance smear defaulted from the third. The median time from the recruitment smear to the first surveillance smear was 7 months (interquartile range 6–8 months). In univariate analyses, at each surveillance smear, younger women were more likely to default (first smear: 16% aged 20–29 versus 2% aged 50–59). Default was slightly higher among women with a mild (12% for first smear) than a borderline (10%) recruitment smear. For the first surveillance smear, women with a college/university degree were less likely (7%) than those without a degree (11%) to default, but this difference was not apparent for subsequent smears. For the first and second surveillance smears, default was higher among smokers than non‐smokers. Multivariate analyses of these and other sociodemographic factors will be presented.Conclusions: Default was 11% from the first surveillance smear and increased slightly with subsequent smears. Some sub‐groups of women are more likely to default (eg younger women, smokers). Analyses such as these may help inform strategies to ensure maximum attendance by women for cytological follow‐up of low‐grade abnormal smears.