TOPLINE

Patients with low-grade squamous intraepithelial lesions or treated for high-grade squamous intraepithelial lesions had more than twice the rate of loss to follow-up when surveillance was conducted by general practitioners compared with gynecologists, although recurrence rates remained low during short-term follow-up.

METHODOLOGY

• A retrospective cohort study compared follow-up adherence between general practitioner-based and gynecologist-based surveillance for cervical precancerous lesions in two non-academic teaching hospitals in the Netherlands from 2018 to 2020.
• A total of 1863 patients were included: 1428 with low-grade squamous intraepithelial lesions (874 followed by general practitioners, 554 by gynecologists) and 435 with treated high-grade squamous intraepithelial lesions (298 followed by general practitioners, 137 by gynecologists).
• Patients with low-grade lesions were scheduled for surveillance cytology and high-risk human papillomavirus testing at 12 months; those with treated high-grade lesions at 6 months, followed by an additional check at 24 months when 6-month cytology was normal. 
• Patients who were referred back to their general practitioner were responsible for scheduling their own follow-up
  appointments, while in gynecologist-based follow-up, appointments were scheduled automatically
• Primary outcome was loss to follow-up, defined as having no follow-up or the first surveillance cytology occurring more than 18 months after diagnosis for low-grade lesions and more than 30 months for treated high-grade lesions, corresponding to a 6-month margin beyond recommended surveillance intervals. Secondary outcomes was disease recurrence during follow-up.

TAKEAWAY

• For low-grade lesions, loss to follow-up at 12 months was significantly higher among patients followed by general practitioners (38.1%) compared with those followed by gynecologists (16.6%; P < .001).
• For treated high-grade lesions, loss to follow-up at 24 months was 44.3% in the general practitioner group vs 24.1% in the gynecologist group (P < .001).
• Subanalysis by year showed significantly higher loss to follow-up rates across all years (2018, 2019, 2020) for patients with low-grade lesions who were followed by general practitioners compared with gynecologists, suggesting the COVID pandemic did not substantially affect adherence patterns.
• Recurrence of disease during follow-up was low in both groups: for low-grade lesions, progression to high-grade lesions occurred in 6.7% of patients followed by general practitioners vs 3.7% followed by gynecologists; for treated high-grade lesions, recurrence was observed in 0.6% vs 2.9%, respectively.

IN PRACTICE

"The relatively high percentage of patients lost to follow-up after surveillance by the general practitioner in this study may be explained by the absence of a structured recall system... This is supported by evidence from several studies, including experiences from Denmark, where general practitioners have been involved in follow-up of cervical cytology for several years," wrote the authors of the study.

SOURCE

The study was led by Lieke van de Kam, Department of Obstetrics and Gynecology, Amphia in Breda, the Netherlands. It was published online in Acta Obstetricia et Gynecologica Scandinavica.

LIMITATIONS

Possible incomplete registration may have influenced patient selection, potentially leading to missed eligible patients and selection bias. Important baseline information such as ethnicity and educational level was absent, which could serve as potential confounders influencing adherence to follow-up. The study had a relatively short follow-up period, making it difficult to determine long-term outcomes such as progression to cervical cancer in patients lost to follow-up. Generalizability is limited to populations without a history of cervical abnormalities, as such patients were excluded.

DISCLOSURES

The study was supported by grants from Amphia Science Fund, Breda, the Netherlands, and Incentive Committee Catharina Hospital in Eindhoven, the Netherlands. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.