Adherence to extended screening intervals means fewer colposcopies
and less exposure to risk of attendant harm.
If one compares the proportions of colposcopies
required that were actually done (36.7% for 2007 v.
Prevention of i case of cervical cancer through screening annually rather than once at 3 years would require an additional 42,621 Pap smears and 2364 colposcopies
for women aged <30 years; 69,665 Pap smears and 3861 colposcopies
for women aged 30 to 44; and 209,324 Pap smears with 11,502 colposcopies
for women aged 45 to 59.
Of more interest to investigators were the women whose initial colposcopies
produced negative biopsy results.
Only patients with single, first-time colposcopies
who were referred because of abnormal cytologic smears were included.
were performed by 52 expert colposcopists.
We then looked at the 19 women with negative results on NIC, cytologic screening, and cervicography who did not receive colposcopies
. Only if a minimum of 9 of these had undetected SIL would the 95% confidence limits of the NPV for the combination of cytologic tests, NIC, and NIC-contingent cervicography begin to overlap those of unaugmented cytologic screening.
Rather, the investigational device is intended to increase the effectiveness of colposcopies
in women with abnormal Pap smears, in whom up to 36% of high-grade lesions can be missed with colposcopy alone.
First, performing 2827 colposcopies
in the private practice setting would be overly time-consuming and prohibitive in cost.
performed on all the women during pregnancy confirmed the presence of high-grade squamous intraepithelial lesions (HGSILs) in 30 patients, low-grade squamous intraepithelial lesions (LGSILs) in 53 patients, and atypical squamous cells of undetermined significance (ASCUS) in 17 patients.
Number Patient Management (N = 200) Percent Follow-up treatment Cryocautery 85 42.5 Cryocautery and 5-fluorouracil 29 14.5 Referral to specialist 29 14.5 None indicated in chart 22 11 Observation and Papanicolaou 19 9.5 smear Returned to primary medical 6 3 doctor Other 6 3 5-Fluorouracil only 4 2 Follow-up Papanicolaou smear None indicated in chart 86 43 Class I 40 20 Class II 56 28 Class III 16 8 Other 2 1 Referred to specialist 28 14 Conization 11 5.5 Laser 5 2.5 Repeat colposcopy 2 1 Colposcopy and cryocautery 2 1 Did not show 2 1 Hysterectomy 1 .5 had repeat colposcopies
by a gynecologist, 2 of whom eventually had cryocautery.
Still, HPV testing wouldn't do much to eliminate unnecessary colposcopies
. Fifty-six percent of the women in the ASCUS group had a positive HPV test, and only a small number turned out to have cervical intraepithelial neoplasia (CIN) III.