Association of cervical cryotherapy with inadequate follow-up colposcopy

OBJECTIVE We studied the anatomic changes that occur in the ectocervix after cryotherapy and the role these changes play in the adequacy of follow-up colposcopic examination. STUDY DESIGN We retrospectively reviewed patients' charts. POPULATION Between January 1, 1991, and December 1, 1995, 268 women underwent 2 colposcopic examinations in 7 state-run public health clinics. OUTCOMES MEASURED The likelihood that a follow-up colposcopic examination would be inadequate. RESULTS Of the 268 women who underwent 2 colposcopic examinations during the study period, 83 had cryotherapy, 24 had loop excision of the ectocervical portion or cervical conization, and 96 had no procedure. Sixty-five were excluded because of missing data. Subjects were similar with respect to age, whether endocervical curettage was performed, presence of cervical dysplasia or human papilloma virus, and whether glandular involvement was noted. Patients who had cryotherapy had an increased likelihood of inadequate follow-up colposcopic examination compared with women who had no procedure (adjusted odds ratio = 18.7, 95% confidence interval = 7.0-49-8). CONCLUSIONS Undergoing cryotherapy of the uterine cervix increases the risk that a follow-up colposcopic examination will be inadequate. Given the reported high rates of regression of mild and moderate cervical dysplasia and the risks posed by possibly unnecessary procedures performed after inadequate colposcopic examination, a trend toward less aggressive therapy and watchful waiting may be appropriate but should he investigated in a controlled clinical trial.