Bosgraaf et al. Overtreatment in a see-and-treat approach to cervical intraepithelial lesions.
Why should you read about this topic?
See-and-treat might be a more efficient approach to high-grade or persistent cervical lesions but at the expense of overtreatment.
What were the authors trying to do?
To estimate the rate of overtreatment in a see-and-treat protocol for cervical dysplasia
Who participated and in what setting?
Women (N=3192) with abnormal Pap smears who underwent a see-and-treat protocol at the Radboud University Nijmegen Medical Center between 1981-2010
What was the study design?
Retrospective database study
What were the main outcome measures?
Overtreatment (CIN 1 or less at final histopathologic analysis)
What were the results?
18% of women were overtreated. The lowest overtreatment rate was in women with a high-grade smear and a high-grade colposcopic impression. The older the woman the greater the rate of overtreatment.
What is the most interesting image in the paper?
What were the study strengths and weaknesses?
Strengths: large study size. Weaknesses: database study; long period of study spanning many significant changes in cervical cancer screening; no cytopathology or histopathology review; missing data in over 25%
What does the study contribute for your practice?
See-and-treat seems to work best when you have a colposcopic impression of a high-grade lesion along with a high-grade Pap smear. Now what we need is a cost-effectiveness analysis of see-and-treat that includes costs of overtreatment.