Reasons for early interventions by gynaecologists in a clinical follow-up study on cervical intraepithelial neoplasia.
OBJECTIVE
In a previous clinical follow-up study on psychosocial factors and cervical intraepithelial neoplasia (CIN), we had noticed a high percentage of early interventions to the cervix by gynaecologists, in discordance with the research protocol. The aim of the current study was to investigate the reasons for these interventions.


METHODS
We retrospectively analysed the study records of the clinical study, concerning the follow-up of 98 patients with a CIN 1 or 2 lesion for 2.25 years by colposcopy and cervical smears. We recorded the number of early interventions that had occurred in the clinical study as well as the reasons for these interventions. A distinction was made between acceptable and unacceptable reasons for early intervention.


RESULTS
During follow-up, 39 out of 98 women (40%) had undergone intervention in discordance with the protocol. No acceptable reason for these interventions was found for 67% of these patients (26/39). In the majority of these cases either no reason for the intervention had been given, or the gynaecologist had feared for progression of the CIN lesion.


CONCLUSIONS
Gynaecologists tend to intervene during follow-up of CIN, partly out of fear for progression. This tendency may complicate follow-up studies on CIN.
Tiersma
E Stella M
ES
Bakhuis RoozenBoomstratt 36, Gynaecology and Obstetrics, 2313 RD Leiden, The Netherlands. emtiersma@yahoo.com
Peters
Alexander A W
AA
van der Lee
Marije L
ML
Visser
Adriaan P
AP
Fleuren
Gert Jan
GJ
D003127:Colposcopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D010352:Patient Dropouts; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000601:surgery*