Objective: A long term review of women after hysterectomy with a history of pre-invasive carcinoma of the cervix.
Design: 193 women had cervical intra-epithelial neoplasia and two had adenocarcinoma in situ either at hysterectomy or at previous cone biopsy. These were followed up by annual cytology.
Setting: South Glamorgan Health Authority.
Subjects: Of 195 women who had a hysterectomy, 143 have been followed up cytologically for more than 10 years and 43 for more than 20 years: a total of 2800 women years of experience.
Main outcome measures: Timing of abnormal smears.
Results: A detailed review of the five women with abnormal smears. The estimated percentage of women who remain negative is 98% at five years, 98.4%, at 10 years and 96.5% at 20 years.
Conclusion: Cytological screening of all women who had a hysterectomy with a history of CIN is indicated for the first two years after hysterectomy. Thereafter the estimated incidence of 0.7 per 1000 women years is higher than the general population but it is not a sufficient reason to screen more frequently. We recommend screening for the carcinoma of the vagina to be every three years which is the same screening frequency as for cervical carcinoma in the general population.