Objectives Interpretation of smears is a challenge in older women owing to atrophic changes. Colposcopy can be difficult and views are often unsatisfactory. 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 establish whether high-grade smear cytology correlates with colposcopic and histological findings in women aged 50 or above and review the employed subsequent management.

Methods A retrospective study was conducted of all women aged 50 years and above, referred to Queen’s Hospital colposcopy unit due to high-grade smear between 2016–2019. An electronic data search was undertaken to establish colposcopy findings, histology of biopsy, LLETZ, or further surgical intervention plus results following tests of cure. Data was analysed using Microsoft Excel.

Results Smear cytology for the 99 women referred demonstrated 1 suspicious of glandular neoplasia, 50 of severe, and 48 of moderate dyskaryosis. 11 patients were excluded due to incomplete data. Colposcopic views were unclear for 27(31%) patients. 82(93%) patients underwent LLETZ. 3 squamous cell carcinomas and 1 adenocarcinoma were detected. High-grade histology was seen in 54 samples (23% CINII and 38% CINIII), low-grade histology in 11(13% CINI), 11% had no abnormality and 10% displayed other benign changes. 10 patients went on to have a total hysterectomy and bilateral salpingo-oophorectomy.

Conclusions A 5% incidence of cancer and 61% high-grade histology was found in this cohort, with 11% undergoing radical surgical intervention. This demonstrates the need for robust cervical screening programmes, particularly in conflicting smear and colposcopy findings.