Introduction/Background*Interpretation of smears is a challenge in older women owing to atrophic changes. Colposcopy can be difficult and views are repeatedly unsatisfactory due to a stenotic os. LLETZ procedures are therefore often performed based on initial high-grade smear cytology. However, approximately 60% of cervical cancers occur in women aged 45 plus; evidence shows a second peak of high-risk HPV in postmenopausal women. This study aims to review the management of women aged 50 years and above with high-grade smears and establish the incidence of cervical cancer in this cohort.
Methodology A retrospective study was conducted; an electronic search was undertaken to identify all women aged 50 years and above referred from the national screening programme with a high grade (moderate or severely dyskaryotic) smear to the Colposcopy unit at Queen’s Hospital & King George Hospital Barking, Havering & Redbridge NHS Trust between 1st January 2016 – 31st December 2019. Infoflex and cyberlab were used to collate data to establish establish colposcopy findings, histology of biopsy, LLETZ, or further surgical intervention plus results following tests of cure. Data was analysed using Microsoft Excel.
Result(s)*Of the 99 women referred, smear cytology demonstrated 1 suspicious of glandular neoplasia, 50 of severe dyskaryosis and 48 of moderate dyskaryosis. 11 patients were excluded due to incomplete data. Colposcopic views were undiagnostic for 27 (31%) of patients. 82 (93%) patients underwent LLETZ, while 11% of patients underwent radical surgery based on their smear +/- histology results. This study identified a 5% incidence of cancer (3 SCC; 1 adenocarcinoma). 61% exhibited high-grade histology (23% CINII and 38% CINIII) and 13% exhibited low-grade histology (CINI). 11% had no abnormality and a further 10% displayed other benign changes.
Conclusion*Our local analyses demonstrate a 5% incidence of cancer in women aged 50 years as per histological diagnosis. 61% of referred patients exhibited high-grade histology; 11% of the sample population underwent radical surgery. This may justify a lower threshold to performing LLETZ procedures where colposcopy findings are indeterminate.
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