Loss to follow-up in patients diagnosed with or treated for low- and high-grade squamous intraepithelial lesions: A comparison of general practitioner- and gynecologist-led surveillance

Introduction: Cervical carcinoma can be prevented by treating precancerous lesions, which are classified as low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions. Follow-up of patients diagnosed with LSIL or treated HSIL is typically conducted in secondary care by a gynecologist. However, this may also be conducted in a primary care setting at the general practitioner. This latter approach offers potential benefits such as lower healthcare costs and care closer to home. However, the effectiveness of follow-up by general practitioners is unknown. Material and Methods: This retrospective cohort study included patients diagnosed with LSIL or treated HSIL by the gynecologist, with no prior history of SIL or cervical cancer, who either underwent cytological follow-up at the gynecologist or the general practitioner. The primary outcome was loss to follow-up at 12 months for LSIL and 24 months for treated HSIL. Results: A total of 691 patients were followed up by the gynecologist, and 1172 by the general practitioner. In the LSIL group, 38.1% (333/874) of patients followed up by a general practitioner were lost to follow-up at 12 months, compared with 16.6% (92/554) of those followed up by a gynecologist (p < 0.001). For treated HSIL, 44.3% (132/298) were lost to follow-up at 24 months in the general practitioner group, versus 24.1% (33/137) in the gynecologist group (p < 0.001). Conclusions: Follow-up by a general practitioner after a diagnosis of LSIL or treated HSIL is associated with nearly twice the rate of loss to follow-up compared to follow-up by a gynecologist.