When do you go beyond the Pap?
June 1, 1998 2 minutes read
When do you go beyond the Pap?
Could overall incidence of cancer be reduced by screening more women less frequently, or should there be more frequent screening - plus adjunctive tests - of those already in the system? In other words, should we improve tests or improve access? Although Pap smears are relatively inexpensive to perform (Medicare allows $27.86 for CPT 88151-26), positive results lead to follow-up diagnostic work that's not only expensive, but in the case of false-positives, unnecessary. The other side of the coin is that even screened populations have a significant incidence of cervical cancer. The public perception that the Pap smear is a precise tool for cancer detection has led to crippling malpractice cases when cancer follows a normal reading.
To determine just how cost-effective screening is, researchers stratified the risk for cervical cancer based on the following risk factors:
· multiple sex partners;
· partners with multiple sex partners or partner with cervical cancer;
· early age of first intercourse;
· current or prior pap infection, condyloma, herpes, or other STDs;
· HIV or immunosuppression;
· smoker or substance abuse.1
The experts advocate annual Pap screening. See http://www.medscape.com/Medscape/ womens.health/1997/v02.n12/wh3023.vasilev/wh3023.vasilev.html on the Internet for an article on this topic.
Reference
1. Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol 1995; 141(7):680-689.
Following are names and telephone numbers of sources quoted in this issue:
Michael Cohen, president, Institute for Safe Medication Practices, Warminster, PA. Telephone: (215) 956-9181.
Julia Roberts, spokesperson, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL. Telephone: (630) 792-5914.
Laura Sarff, RN, CPHQ, director, quality improvement department, Los Angeles County (CA) Health Department. Telephone: (213) 240-8283.
Lucian L. Leape, MD, Department of Health Policy and Management, Harvard School of Public Health, Boston. Telephone: (617) 432-2008.
Shawn C. Becker, BSN, RN, manager, program development, United States Pharmacopeia Convention, Rockville, MD. Telephone: (301) 881-0666.
Elgin K. Kennedy, MD, editor, The Assertive Utilization and Quality Report, San Mateo, CA. Telephone: (415) 348-3647.
Renee H. Martin, JD, RN, MSN, Kalogredis, Tsoules and Sweeney Ltd., Wayne, PA. Telephone: (610) 687-8314; e-mail: ADMIN@KTSHealthLaw. com; Web site: www.KTSHealthLaw.com.
Sue Larson, RN, director, quality improvement and venipuncture team coach, Bay Area Medical Center, Marinette, WI. Telephone: (888) 788-2070, ext. 4049.
Becky Ziegler-Otis, RN, director, performance improvement and utilization management, Bay Area Medical Center, Marinette, WI. Telephone: (888) 788-2070, ext. 3265.
Irwin Press, PhD, co-director, Press, Ganey Associates, South Bend, IN. Telephone: (219) 232-3387; e-mail: [email protected]; Web site: http://www.pressganey.com
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