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Sir,

In their article on the long term follow up of women after hysterectomy with a history of pre-invasive cancer of the cervix, Wiener et al. (1992) state that present policy is for ‘indefinite annual vault smears following hysterectomy for pre-invasive lesions of the cervix’.

This may be the policy in their area, but it is not the policy of the National Health Service Cervical Screening Programme. The Guidelines for Clinical Practice and Programme Management state that ‘women who have had a hysterectomy for premalignancy should have persistent disease excluded by cytology at six months and one year and then no further smears provided the CIN has been completely removed’ (Duncan 1992).

The lesson that Wiener et al. draw from their study is that post hysterectomy, surveillance can be relaxed to the normal three year interval. The lesson that those of us that have been following the national guidelines must draw is that the policy of cancelling recall following hysterectomy is wrong. The guidelines should be amended to take account of the risk of development of vaginal cancer.

References

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  2. References
  • Duncan I. (1992) Guidelines for Clinical Practice and Programme Management. NHS cervical screening programme, national coordinating network..
  • Wiener J. J., Sweetnam P. M. & Jones J. M. (1992) Long term follow up of women after hysterectomy with a history of preinvasive cancer of the cervix. Br J Obstet Gynaecol 99, 907910.