Should patients with mild atypia in a cervical smear be referred for colposcopy?

Significant premalignant disease of the cervix was found in 37% of women referred to a colposcopy clinic because of a smear that showed no more than mildly atypical cells, and in 49% of women whose smears showed mild dyskaryosis. This did not seem to be related to the number of times the abnormal smear had been repeated and was not confined to patients whose smears had been reported by only one laboratory. In another group of 102 women whose first abnormal smear was graded as atypical: 10 had cervical intraepithelial neoplasia; 9 still had abnormal smears and 27 had been lost to follow-up, possibly because the potential importance of this finding was not recognised by the doctor to whom the smear report had been returned. Women with midly atypical or mildly dyskaryotic smears are at considerable risk of having cervical intraepithelial neoplasia. All patients with a smear report showing dyskaryosis of any degree of severity should be referred for colposcopy. Those with atypical cytology should be referred for colposcopy if a second smear, repeated after 3 months, is not normal.