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Management Choice and Adherence to Follow‐up After Colposcopy in Women With Cervical Intraepithelial Neoplasia 1

OBJECTIVE To determine women's preference when given a choice of management between cryotherapy and cytology surveillance and to compare subsequent adherence to serial cytologic follow‐up after being diagnosed with cervical intraepithelial neoplasia grade 1 (CIN1). METHODS Two hundred nineteen low‐income women with biopsyproven CIN1 seen in a reproductive health clinic from August 1995 through December 1999 were offered cryotherapy or cytology surveillance, followed by cytologic testing every 4 months until three consecutive results were normal. Endpoints of the study were: successful completion of follow‐up; transferred or referred out of clinic; or lost to follow‐up. RESULTS Ninety‐four women (42.9%) chose cryotherapy, compared with 125 women (57.1%) who chose cytology surveillance (P < .05). Cryotherapy patients were more likely to return for at least one visit (their treatment visit) after colposcopy compared with cytology surveillance patients (P < .001). In contrast to their initial return for treatment of 98.9%, cryotherapy patients were less likely to return for their first follow‐up cytology visit compared to surveillance‐only patients (68.1% and 83.2%, respectively, P < .01). Thirty‐seven percent of the total group successfully completed follow‐up at the clinic, 30.1% transferred or were referred, and 32.9% were lost to follow‐up. CONCLUSION Successful completion of a commonly recommended protocol for serial cytology follow‐up was low. Management choice affected initial adherence but not adherence to long‐term follow‐up.