Loss to follow-up in patients diagnosed with or treated for low- and high-grade squamous intraepithelial lesions: A comparison of general practitioner- and gynecologist-led surveillance.

INTRODUCTION

Cervical carcinoma can be prevented by treating precancerous lesions, which are classified as low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions. Follow-up of patients diagnosed with LSIL or treated HSIL is typically conducted in secondary care by a gynecologist. However, this may also be conducted in a primary care setting at the general practitioner. This latter approach offers potential benefits such as lower healthcare costs and care closer to home. However, the effectiveness of follow-up by general practitioners is unknown.

MATERIAL AND

METHODS

This retrospective cohort study included patients diagnosed with LSIL or treated HSIL by the gynecologist, with no prior history of SIL or cervical cancer, who either underwent cytological follow-up at the gynecologist or the general practitioner. The primary outcome was loss to follow-up at 12 months for LSIL and 24 months for treated HSIL.

RESULTS

A total of 691 patients were followed up by the gynecologist, and 1172 by the general practitioner. In the LSIL group, 38.1% (333/874) of patients followed up by a general practitioner were lost to follow-up at 12 months, compared with 16.6% (92/554) of those followed up by a gynecologist (p < 0.001). For treated HSIL, 44.3% (132/298) were lost to follow-up at 24 months in the general practitioner group, versus 24.1% (33/137) in the gynecologist group (p < 0.001).

CONCLUSIONS

Follow-up by a general practitioner after a diagnosis of LSIL or treated HSIL is associated with nearly twice the rate of loss to follow-up compared to follow-up by a gynecologist.