British Journal of General Practice

After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial.Cotton S, Sharp L, Cochran C et al (2011) 61(587) e333-339.

This is a retrospective, cohort, multicentric study from Grampian, Tayside and Nottingham including 1120 women recruited for the TOMBOLA trial (Trial Of Management Of Borderline and Other Lowgrade Abnormal Smears). The aim of the study was to detect the percentage of patients suffering from pain, bleeding and discharge as a recognised complication six months after cervical cytology. Also they reported duration, severity of symptoms and socioecodemographic factors related (which mainly were age, level of physical activity, post school education, smoking, parity, employment status, use of oral contraception) .This is done only in women that had a initial cytology with low grade abnormality in the cytology. A questionnaire is used six weeks after the cytology with five point scale. The age group was between 20-59 years.

Simple non repetitive style was used and a simple graph easy for the reader to understand, nevertheless P value was not used in the analysis. As for results in summary, 79% of women completed the questionnaire, 14.8% reported pain, 16.1 % reported bleeding, and 7.1 % reported discharge, 30% of women reported at least one after effect. The authors did not declare the percentage of the women reported more than one after effect (which could be expressed in an intersecting graphs or circles). Apparently all the after effects were very mild, duration of symptoms were relatively longer in favor of discharge. Less bleeding was seen in smokers, more discharge was seen in OCP users, more bleeding in nulliparous. Despite this no percentages was mentioned in this abbreviated version. Pain and discharge decreased with increasing age. The only percentages given were for age relation.

In their discussion the authors mention that this is the first study for this group of women, the questionnaire response was high. They also felt that the after effect was assessed in a good way as it is from the women perspective. We have to bear in mind however, that different patients have different ways of interpreting the severity of symptoms. Also this depends on the women's recall.

The main week point that it is a retrospective study and it was assumed that after effects will settle or decrease within six weeks and perhaps that is why the questionnaire was done during this time frame. They also compared the after effect with colposcopy (which is a different modality for assessment) and observed that the incidence of bleeding was more, while pain, discharge was less for cervical cytology.

Another point to draw the attention of the reader to is that, this was a truncated report from a larger one adapted for this journal. Interested readers would need to check on the BSCCP websites to links to the other aspects of the TOMBOLA study e.g. www.mrc.ac.uk. Eight authors were listed on this study. I think the most authors for any one paper was 15.

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