OBJECTIVES: To evaluate the management and the management cost of follow-up of women with abnormal Pap result in 5 countries (UK, Australia, Germany, Spain & Italy). METHODS: A retrospective chart review of resource use was conducted in 33 centres within the five countries. Historical data was collected on >3000 women with an abnormal Pap smear over a 2-year treatment and follow-up period starting from year 2002. The study population was stratified to include a minimum number of subjects per cytology category: 35% mild, 25% moderate, 25% severe dyskaryosis, and 15% cervical cancer. If not enough cancer cases were enrolled in a country additional cases were searched for. Unit costs for treatment were calculated from country-specific cost databases. We compare overall and between-countries overall age and age distribution; correlation between cytology and histology; resource use and cost per histology group after purchasing power parity adjustment. RESULTS: Overall mean age of patients (n=3380) was 36.3y old (min=16y, max=90y). Patients with histologically confirmed invasive cancer (n=333) were on average 48.8 years (min=21y, max=85y). Proportion of patients in each confirmed pre-cancer group was: CIN-1=17.1%; CIN-2=18.6%; CIN-3=29.9%. Negative evaluations after first inspection and/or biopsy were 24% and cancer cases seen and confirmed were 9.9%. The correlation coefficient between cytology and histology findings overall was 62.6, but varied widely across countries. Resource use such as number of pap smears per stage, colposcopies, and LEEPs shows significant differences across countries and per histology stage (p<0.05). The initiation of treatment and type of treatment per histology stage varied considerably within each country and across the aggregate database. CONCLUSION: Weak correlations between cytology and histology across all countries were observed. Average cost per histology varies by country and can be substantial. Large cost SDs per histology stage indicate that it remains difficult to standardise treatment for early stages.