Conundrum in primary care: should all cervical polyps be removed?

Background: The management of asymptomatic cervical polyps has long been debated due to the scarcity of literature and guidelines regarding the need for polypectomy. While the majority of cervical polyps are diagnosed incidentally by GPs during routine cervical smears, there are no clear recommendations on referral pathways for further histological investigations.
Aim: To investigate the need for polypectomy in women presenting with asymptomatic polyps. In addition, the study explores potential suggestions and guidelines for the referral of asymptomatic cervical polyps in general practice.
Method: A retrospective study on the histological findings of extracted cervical polyps examined by the pathology department at the Countess of Chester Hospital (COCH) over 9 years (2010- 2019).
Results: Of the 514 patients presented with cervical polyps (74% were asymptomatic), approximately 97% of the referrals made were by GPs. Additionally, we identified 74 inappropriate referrals through the 2-week wait cancer pathway. Overall, there were no malignant samples and five (0.97%) premalignant lesions were presented.
Conclusion: This study supported the evidence that most cervical polyps are benign. However, inappropriate referrals prompt more education on cervical pathologies. Furthermore, there is a need for robust guidelines on the management of asymptomatic cervical polyps in general practice. To lessen the financial burden of managing cervical polyps in a secondary care setting, workshops on polyp removal can be developed for GPs.
(© British Journal of General Practice 2024.)