Improving the follow-up of patients with abnormal Papanicolaou smear results
D. McKee
Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. mckee@aecom.yu.edu
A review of the literature on adherence with recommended follow-up after an
abnormal screening Papanicolaou smear result reveals that many women do not
receive adequate follow-up. Primary care providers can influence the number
of women who undergo timely colposcopy or a subsequent Papanicolaou smear
by addressing common barriers to follow-up. Physicians should anticipate
fears commonly experienced by women when they learn of abnormal
Papanicolaou smear results, including fear of cancer, fear of pain during
colposcopy, and fear of loss of sexual or reproductive function. An
awareness that certain populations are at especially high risk of
inadequate follow-up, including black and Hispanic women, women with less
than a high school education, and women of low socioeconomic status, can
help physicians target their efforts. Practical strategies for improving
follow-up include speaking directly with the patient about results,
emphasizing the precancerous nature of most lesions, actively preparing the
patient for colposcopy by describing the procedure and its complications,
and addressing fears about the common treatment options for cervical
intraepithelial neoplasia. Office-based reminder systems and educational
materials may also be used as adjuncts to personal contact.
