Every woman with an abnormal cervical smear should be referred for treatment: debate

Clin Obstet Gynecol. 1995 Sep;38(3):585-91. doi: 10.1097/00003081-199509000-00018.


No dispute exists regarding the optimal management of women with moderate or severe dyskaryosis (high grade SIL). These women should have a colposcopic assessment and biopsy. Women with borderline nuclear abnormalities should have a repeat smear and undergo colposcopy only if the abnormality persists. Low-grade abnormalities (low-grade SIL) are common, and their management is relevant. We suggest that these women be referred for an immediate colposcopic assessment for the following reasons: a. a policy of cytologic surveillance allows an opportunity for default, and these women are at an increased risk of invasive cancer. b. a significant proportion of these women will have underlying CIN grade III that should be treated. c. a minority of these women revert to cytologic normality without a recurrent dyskaryotic smear and, therefore, eventually will be referred to colposcopy. d. a policy of immediate referral to colposcopy may be financially less expensive and avoid unnecessary anxiety to the woman during the period of undergoing repeated smears.

Publication types

  • Review

MeSH terms

  • Cervical Intraepithelial Neoplasia / pathology*
  • Cervical Intraepithelial Neoplasia / therapy
  • Clinical Protocols
  • Colposcopy
  • Cost-Benefit Analysis
  • Decision Trees
  • Female
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods*
  • Patient Selection*
  • Referral and Consultation*
  • Treatment Outcome
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / therapy
  • Vaginal Smears*