ITH THE I m R E A s E D USE of vaginal cytology, serious cervical abnormalites are being found more frequently in young women.3 In this particular group of patients, the general acceptance of the comforting concept that carcinoma of the cervix is a "preventable disease" has spiralled us into a thundering crescendo of problems.
Because of the increasing number of women who are found to have intraepithelial carcinoma of the cervix in the third decade of life, an alternative to hysterectomy is being sought. The experience of having removed the uterus for this lesion in a young childless woman, only to find that the organ showed no residual cancer, has led many gynecologists to seek a more logical method of selecting patients for hysterectomy. Ideally, the decision on future management should be made while the patient is in the hospital. Many young women with a diagnosis of carcinoma in situ based on the examination of a conization specimen are being dismissed from the hospital and followed closely with frequent cytological examinations. This conservative approach allows the patient to maintain her childbearing function and many women show no further cytological or histological evidence of cervical carcinoma.
Unfortunately, the outcome is not always such a happy one. Some patients, despite their former good intentions, fail to attend for follow-up examinations. Furthermore, many women continue to exfoliate malignant cells while others who have a negative cytology immediately after conization later revert to a positive state. T h e persistent or recurrent