title: Colposcopic episodes of care: referral, treatment, follow-up, and exit patterns of care for women with abnormal pap smears.
abstract: OBJECTIVE
  To define the patterns of care of women after they have been referred to a colposcopic service.
  
  
  METHODS
  We carried out this population-based study by linking databases of health care provision for 2010. We defined "colposcopic episodes of care" as a series of colposcopic evaluations beginning at the time of referral for colposcopy because of a new cervical cytology abnormality and continuing until no colposcopy or cytology service had been performed for ≥ 365 days.
  
  
  RESULTS
  Cytology reports indicating low-grade squamous intraepithelial lesions and atypical squamous cells of uncertain significance account for 88% of referrals of women for colposcopy. Women aged 20 to 29 had the highest rates of referral and treatments. Up to 87% of women referred for low-grade squamous intraepithelial lesions cytology did not require treatment after colposcopic evaluation, while 54% of women referred for high-grade squamous intraepithelial lesions cytology required treatment. The duration of colposcopic episodes of care in which treatment was carried out lasted up to 327 days, with a median three colposcopic evaluations per episode, whereas episodes of care in which no treatment was carried out lasted up to 190 days with a median of one or two colposcopic examinations per episode.
  
  
  CONCLUSIONS
  Young women aged 20 to 29 have the highest rates of colposcopic services. Women referred because of cytology showing high-grade squamous intraepithelial lesions in whom treatment is not carried out require more extensive follow-up to ensure that lesions are not missed. We recommend the incorporation of colposcopy services into centralized cervical cancer screening programs.
authors: Division of Gynecologic Oncology, Sunnybrook Regional Cancer Centre, University of Toronto, Toronto ON.
authors: Rachel
authors: R
authors: Kupets
authors: Institute of Clinical Evaluative Sciences, Toronto ON.
authors: Yan
authors: Y
authors: Lu
authors: Division of Gynecologic Oncology, Sunnybrook Regional Cancer Centre, University of Toronto, Toronto ON.
authors: Danielle
authors: D
authors: Vicus
authors: Institute of Clinical Evaluative Sciences, Toronto ON.
authors: Lawrence
authors: L
authors: Paszat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D012017:Referral and Consultation; D002578:Uterine Cervical Dysplasia / Q000601:surgery*; D014626:Vaginal Smears; D055815:Young Adult
keywords: cervical dysplasia; colposcopy; patterns of referral