When do you go beyond the Pap?
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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