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TOMBOLA randomised controlled trial
Immediate colposcopy referral in women with low-grade abnormal results on cervical cytology detects more CIN2 or worse lesions than cytological surveillance in primary care, but might lead to overtreatment
  1. Marc Arbyn1,
  2. Pierre Martin-Hirsch2,
  3. Frank Buntinx3,4
  1. 1Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
  2. 2Central Lancashire Teaching Hospitals, Preston, UK
  3. 3Belgian Centre of Evidence-Based Medicine, University of Leuven, Leuven, Belgium
  4. 4Department of General Practice, University of Leuven, Leuven, Belgium and University of Maastricht, Maastricht, The Netherlands
  1. Correspondence to Marc Arbyn
    Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstreet 14, B1050 Brussels, Belgium; marc.arbyn{at}

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Most women with a Pap smear showing minor abnormalities, detected in the framework of cervical cancer screening, do not have or will not develop clinically significant disease. Minor cytological abnormalities are classified by UK cytological criteria as borderline or mild dyskaryosis, which can be translated into international terminology as ASCUS (atypical squamous cells of undetermined significance) or LSIL (low-grade squamous intraepithelial lesions), respectively.

According to a recent meta-analysis, the absolute risk of underlying high-grade cervical intraepithelial neoplasia (grade II or III or worse (CIN2/3+)) among women with ASCUS is on average 9–10% for CIN2+ and 4–5% for CIN3+. For women with LSIL, these risks are about 1.5 to 2 times as high.1 These risks are 10 to 30 times higher than for women with normal cytology. The probability that high-grade CIN will …

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  • Competing interests None.