The case for early intervention ('see and treat') in patients with dyskaryosis on routine cervical screening.
'See and treat' colposcopy using an excisional technique (usually LLETZ) is very attractive to patients and practitioners. It is therapeutically effective, efficient and cost-effective within the context of the screening programme. It is, of course, inappropriate to excise the transformation zone of any woman who attends the clinic with an abnormal smear. The question should however be, 'Is there a reason why I should not see and treat', rather than 'why should I see and treat'. Reasons for avoiding 'see and treat' comprise patients' preference and young age coupled with minor cytological or histological abnormalities (i.e. mild dyskaryosis or less and CIN 1 or less). This is because many minor problems will resolve without therapy and because long-term data collection may show effects about which we know nothing. I would argue that for patients with mild abnormalities who are older or their fertility is not an issue, 'see and treat' is appropriate because the treatment morbidity is so low and they are at higher risk of having significant lesions than young women. Finally, for patients with more severe abnormalities, the timing of the treatment is irrelevant, and the only argument against 'see and treat' is patient preference.
Murdoch
J B
JB
Directorate of Obstetrics, Gynaecology and ENT, St Michael's Hospital, Bristol, UK.
D003127:Colposcopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D002577:Uterine Cervical Diseases / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000601:surgery*