REPEATING PAP SMEAR AT TIME OF COLPOSCOPY DETERMINED TO BE UNNECESSARY

Gynecologic Oncology, Journal for the Society of Gynecologic Oncologists, Reports Findings That Additional Test Has Limited Clinical Benefits

CHICAGO, OCTOBER 16, 1997--The need for repeating a Pap smear at the time of colposcopic exam for an initial abnormal Pap has long been debated by gynecologists. A study published in the October issue of Gynecologic Oncology, the scientific publication of the Society of Gynecologic Oncologists (SGO) has found this practice to be of limited medical value, and the researchers claim that eliminating this unnecessary test could result in a national annual savings of $24 million in medical costs. Presenting their research results were Mark Spitzer MD, Michael Ryskin MD, and Alexander Shifrin MD, all from the Department of Obstetrics & Gynecology, Queens Hospital Center (QHC), Jamaica, NY, and Ann E. Chernys, MD, from the QHC Department of Pathology.

When a Pap smear reveals the presence of abnormal or pre-cancerous cells in the cervix, the next step is to perform colposcopy, a visual examination of the vagina and/or cervix with the use of a magnifying endoscope. It has been an accepted medical practice to repeat the Pap smear immediately prior to colposcopy to help validate the initial findings since the referral Pap smears are often unavailable. Physicians who disagree with this practice state that repeating the Pap smear may cause bleeding or strip the cervical epithelium (outer layer of cells on the cervix), possibly compromising the colposcopy.

To determine if a repeat Pap smear was medically justifiable, the New York medical team reviewed 2,969 records of patients at Queens Hospital Center who had a Pap smear prior to colposcopy between 1984 and 1995. Data were gathered from the referral Pap smear, the repeat Pap smear, and the results of any biopsies taken at the colposcopy. A repeat Pap smear was deemed medically justifiable if it had changed the patient's management. For example, if the repeat Pap smear suggested cancer, where the referral test did not and if the findings were not identified on the colposcopy directed biopsy.

Of the 2,969 records reviewed, 312 women had more abnormal cells identified by a repeat Pap smear than were found by the referral Pap smear. However, 236 of the 312 women had those abnormalities detected by a colposcopy-directed biopsy. The remaining 76 women (or 2.7% of the entire research population), had a high grade abnormality found on repeat Pap smears that was not seen at colposcopy, thereby requiring changes in their case management. At the Queens Health Center, this would require the patient undergoing a Pap smear and colposcopy within six months, or a cone biopsy depending on the degree of abnormality.

The researchers concluded that eliminating the repeat Pap smear would not result in missed cervical cancers and would reduce medical costs at a rate of $24.23 per patient.

"The study done by Dr. Spitzer exemplifies the research now being conducted by gynecologic oncologists," said Dr. Peter Schwartz, President of the Society of Gynecologic Oncologists, also Professor in the OB/GYN Department at Yale University School of Medicine. He added, "The results of this study will offer new standards of practice that will result in significant reductions in health care costs and yet provide quality care."

The Society of Gynecologic Oncologists (SGO) is the only United States-medical organization dedicated to the prevention, detection, and cure of female cancers. Internet: www.sgo. Gynecologic Oncology is published by Academic Press. Editor's Note: For the full abstract or questions, contact Johanna Spangenberg at (703) 527-7424.