Surgical management and follow-up of patients with cervical cancer: survey of gynaecological oncologists in the UK.

We investigated current surgical management and follow-up of women with cervical cancer focusing on treatment of recurrent disease and the use of routine imaging during follow-up among gynaecological oncologists in the UK. A questionnaire including questions regarding perioperative management of primary disease in cervical cancer, follow-up post-treatment, assessment and management of recurrent cervical cancer, was sent to 84 gynaecological oncologists. Some 87% responded. Considerable variations in surgical management and follow-up were identified. With central recurrence of cervical cancer without prior radiotherapy, 90% would recommend radiotherapy instead of an exenteration. For central recurrence in irradiated women, only three (4%) would not recommend an exenteration. In women with pelvic sidewall relapse without prior radiotherapy, 65 responders (96%) would offer radiotherapy, while in pelvic sidewall relapse post-radiation 25 (37%) would recommend pelvic sidewall resection in a specialised centre. A total of 21% used routine imaging during follow-up. The wide variation in clinical practice indicates that there is a need to establish national guidelines for surgical management and follow-up of primary and recurrent cervical cancer.

Can default rates in colposcopy really be reduced?

A prospective postal questionnaire study aimed to identify variables that predict a woman's intention to attend and her subsequent attendance/default at colposcopy clinics. One thousand two hundred and fifty-eight women attending colposcopy clinics of a university hospital were sent a postal questionnaire 3 weeks before their second appointment at colposcopy. An intention to attend the colposcopy clinic was the most significant predictor for colposcopy attendance during the next 15 months. Smoking and a longer travel time were associated with default. Our study shows that while interventions tried by service providers can reduce default rates, there will remain a cohort of women who do not fully participate in the screening programme.

Do women with high-grade cervical intraepithelial neoplasia prefer a see and treat option in colposcopy?

OBJECTIVE: To compare women's experiences of either see and treat (ST) or defer and treat (DT) at first visit to colposcopy following abnormal cytology. DESIGN: A prospective postal questionnaire survey. SETTING: Colposcopy clinics of a University Hospital. SAMPLE: A total of 272 women with high-grade cervical intraepithelial neoplasia (CIN) referred to colposcopy. METHODS: A total of 136 women receiving ST and a matched sample of women receiving DT (N = 136) were sent a postal questionnaire 7 days after first appointment at colposcopy to assess evaluations of their experience, psychological distress and relief. Subsequent appointment keeping was extracted from medical records. MAIN OUTCOME MEASURES: Anxiety and subsequent behaviour. RESULTS: Women undergoing ST were significantly less anxious and more relieved than those undergoing DT. They also evaluated their first appointment as more motivationally congruent. While women undergoing ST were less likely than DTs to keep their second appointment, there was no overall difference in did not attend (DNA) rates at 15-month follow up. CONCLUSIONS: ST is psychologically beneficial and may be preferred by women with CIN2/3.