Management of Patients with Atypical and Low-grade Pap Smear Abnormalities

Family physicians frequently encounter patients with atypical and low-grade Papanicolaou (Pap) smear findings. While near consensus exists regarding the evaluation and management of patients with high-grade dysplasia and carcinoma detected on Pap smear, the appropriate management of patients with atypical and low-grade abnormalities continues to be controversial. Recent guidelines from the National Cancer Institute propose consideration of a more conservative management approach, with repeat Pap smear as an alternative to immediate colposcopy. Conservative management, as an alternative to an ablative or excisional procedure, has also been proposed for women with histologic evidence of lowgrade dysplasia. It is unlikely that an approach including a conservative diagnostic strategy and careful follow-up will result in an increase in the number of missed cases of cervical cancer. This assumption needs to be assessed by prospective clinical trials.