Gynaecological care of women with abnormal Pap smears: how varied is current practice?
OBJECTIVE
To assess the current management by gynaecologists of women with abnormal Papanicolaou (Pap) smears.


METHODS
Self-administered survey of all gynaecologists registered in New South Wales.


RESULTS
242 gynaecologists (73% response rate) returned completed questionnaires. Accredited laboratories were used by 90% of gynaecologists, but only 61% could confirm their laboratories' participation in quality assurance procedures. Consensus on the management of high grade Pap smear abnormalities was confirmed. In contrast, there was considerable variation in the management of minor lesions, provision of patient information and follow-up after treatment. A small but worrying minority of respondents indicated an apparent misunderstanding of important colposcopic principles: 41% were prepared to institute ablative therapy without histological diagnosis.


CONCLUSIONS
Given the nature of practice variation documented in this survey, publication of national guidelines is necessary to improve the screening program. Guidelines in themselves, however, will not be sufficient to ensure that all women with abnormal results of Pap smears receive appropriate and timely management and follow-up. Active dissemination to reduce undesirable variation is required.
Wain
G V
GV
Westmead Hospital, Sydney, NSW.
Ward
J
J
Towler
B P
BP
D000328:Adult; D016009:Chi-Square Distribution; D003127:Colposcopy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D065006:Papanicolaou Test; D011230:Precancerous Conditions / Q000175:diagnosis; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000592:standards / Q000706:statistics & numerical data