Is Colposcopic Biopsy Overused among Women with a Cytological Diagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS)?

Abstract

Background:

The diagnosis of atypical squamous cells of undetermined significance (ASCUS) during cervical screening indicates cellular abnormality but is not sufficient for a definitive diagnosis of a squamous intraepithelial lesion (SIL). Before the 2001 consensus guidelines for the management of women with cervical cytological abnormalities are introduced, follow-up management of ASCUS women by colposcopic biopsy is done at patient and physician discretion.

Methods:

In this study, we examined variables associated with the method of follow-up (colposcopic biopsy, repeat Pap smear) in a sample of 651 women(ages 18-82 years) who were diagnosed with ASCUS and were then referred for either a colposcopic biopsy or a repeat Pap smear at their next follow-up appointment.

Results:

In a multivariate logistic regression analysis (outcome variable = follow-up by colposcopic biopsy or by repeat Pap smear), we found that the odds of follow-up by colposcopic biopsy were 8-fold (OR 8.5, 95% CI 4.4-16.3) higher for high-income (>$47,117 vs. <$24,767) women, 2-fold higher (OR 2.8, 95% CI 1.5-5.1 ) for women with private insurance (relative to Medicaid), and 3-fold higher (OR 3.1, 95% CI 1.3-7.4) for middle-aged women (ages 36-45 vs. > 55 y).

Conclusions:

In stratified analyses, we found that high income was positively associated with odds of colposcopic biopsy in all strata of health coverage and that among those in the highest income category, private insurance remained an indicator of colposcopic biopsy use. Our findings raise the possibility that among women with ASCUS, there is an overuse of colposcopic biopsy by high-income and privately insured women who are likely to be at low risk of cervical malignancies.