Cost‐effectiveness of routine cytological cervical surveillance following treatment for carcinoma of cervix

Objectives: The cost‐effectiveness of routine cervical cytology during follow‐up after treatment for carcinoma of cervix is examined. Subjects: All patients having routine follow‐up smears during the financial year 1993–1994. A total of 212 patients generated 311 smears, 96 had an intact cervix and 116 had surgical removal as part of their treatment. Ninety‐one patients with intact cervices and 109 without were evaluable. Results: Nine recurrences were detected, in every case this was expected, based on clinical findings. In two of these the smear was reported as normal. Two hundred and thirty smears were from entirely asymptomatic patients. Conclusions: Limiting cervical smears to those who are symptomatic, or where an abnormality is found on examination, would save approximately £3500 per year. This cost needs to be set beside the possibility of detecting an asymptomatic recurrence at an early stage; as reported by others. This suggests that the impact of this strategy is limited. A randomized trial with prospective economic assessment would be the only way to evaluate the cost‐effectiveness of routine cervical smears in the follow‐up of patients treated for cancer of cervix.