Follow-up of screening patients conservatively treated for cervical intraepithelial neoplasia grade 2–3

• Published in: European journal of obstetrics & gynecology and reproductive biology 2007-08, Vol.133 (2), p.227-231
• Main Authors: Cristiani, Paolo, De Nuzzo, Maria, Costa, Silvano, Prandi, Sonia, Davi, Dino, Turci, Marco, Naldoni, Carlo, Schincaglia, Patrizia, Caprara, Licia, Desiderio, Franco, Manfredi, Marilena, Farneti, Massimo, Collina, Natalina, Falcini, Fabio, Dataro, Pier Giorgio, de Bianchi, Priscilla Sassoli, Bucchi, Lauro
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - therapy; Female; Female genital diseases; Follow-up; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Italy - epidemiology; Mass Screening; Medical sciences; Middle Aged; Obstetrics and Gynecology; Treatment; Treatment Outcome; Treatment Refusal; Tumors; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - therapy
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2006.05.020

Abstract Objectives To evaluate the frequency and correlates of non-adherence to follow-up among patients conservatively treated for CIN2-3. Study design Study population comprised 1560 patients aged 25–64 years from a screening programme in northern Italy. The regional standard protocol was used as a reference. Multinomial logistic regression analysis was used to estimate the odds ratio probability of a patient being lost to follow-up (no check-ups within 27 months of treatment) or incompletely followed-up (1–3 negative check-ups) versus having 4 negative check-ups. Results Three hundred twenty-six patients (21%) were lost to follow-up, 678 (43%) were incompletely followed-up, 352 (23%) presented for 4 negative check-ups and 204 (13%) were diagnosed with persistent disease. The probability of no or incomplete follow-up was greater for patients who lived in the urban district, who were treated in private settings (versus screening centres), who exhibited a visibile squamocolumnar junction on pre-treatment colposcopy, who were treated with cold knife excision and local destructive therapy (versus loop diathermy excision), and whose surgical specimens had positive excision margins. Conclusions Adherence to the reference protocol was poor. Factors involved in follow-up failures require greater clinical attention.