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Editor's Comment
Marjorie A. Bowman, MD, MPA
Arch Fam Med. 2000;9:721.
Papanicolaou (Pap) smears are considered a cost-effective screening tool, but there continue to be cases of preventable cervical cancer. This study considers the potential cost-effectiveness of an alternative method of screening: combining the Pap test once every 2 years with speculoscopy compared with annual Pap tests. The techniques used in this study were excellent. The project was undertaken with the financial support of the company that produces the product. My reservation is that the original articles (references 13 and 14) from which data were obtained to complete this analysis included relatively few women with significant pathological findings. In the study by Mann et al,13 there were 29 women with significant pathological findings (atypia with condylomatous features or cervical intraepithelial neoplasia), and in the study by Wertlake and colleagues,14 there were 191 women with low-grade and 32 with high-grade squamous intraepithelial lesions. No carcinomas in situ were found. Of course, many Pap smears and speculoscopies had to be done to find even this number with pathological results. It is also clear that adjunct speculoscopy will markedly increase the number of false-positive diagnoses, which may have important implications for quality of life and patient interactions. Additional work should be done to verify and expand the work of these authors before widespread adoption of this technique is indicated.
RELATED ARTICLE
Cost-effectiveness of the Conventional Papanicolaou Test With a New Adjunct to Cytological Screening for Squamous Cell Carcinoma of the Uterine Cervix and Its Precursors
Lynn A. Taylor, Sonja V. Sorensen, Nancy F. Ray, Michael T. Halpern, and Diane M. Harper
Arch Fam Med. 2000;9(8):713-721.
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