The Mildly Abnormal Cervical Smear: Patient Anxiety and Choice of Management

Argument continues over the best management of women with a first mildly dyskaryotic cervical smear: should they be referred for prompt colposcopy, or should they be kept under cytological review, with recourse to colposcopy if the abnormality persists? One consideration is the amount of anxiety generated. We measured anxiety, retrospectively, in two groups of women who had been managed by one or other method. Colposcopy caused more anxiety than cytological surveillance. When told that their smear was mildly abnormal, 47% of the immediate-colposcopy group (n = 182), compared with 33% of the surveillance group (n = 163), thought they had cancer. None the less, there was a general preference for immediate colposcopy. Whatever the relative merits of these two strategies for clinical management, it is clear that both forms of screening, and especially colposcopy, demand better information for patients.