Navigation Links
Conventional, annual Pap smear cost-effective follow-up after cervical lesion treatment
Date:10/20/2010

(SACRAMENTO, Calif.) A study of the options for reducing cancer incidence and mortality among women who have been treated for precancerous cervical lesions found that an annual conventional Pap smear is a cost effective strategy.

Joy Melnikow, professor in the Department of Family and Community Medicine and colleagues tested several follow-up screening strategies for the 500,000 American women diagnosed and treated for cervical intraepithelial neoplasia (CIN), abnormal cervical cell growth that can lead to cervical cancer. The first comprehensive study of its kind, "Surveillance After Treatment for Cervical Intraepithelial Neoplasia" will be published in the November issue of Obstetrics & Gynecology.

"This is a large and growing pool of women who need follow-up after treatment," said Melnikow, who is also director of the UC Davis Center for Healthcare Policy and Research. "But we've had few studies on which to base recommendations for follow-up."

Detection and treatment of these pre-cancerous lesions have led to large reductions in cervical cancer incidence and death in many countries where screening is routine. But current recommendations about follow-up over time vary widely, and the use of newer technologies had not been fully evaluated until now, Melnikow said.

Melnikow and her colleagues examined the relative benefits and costs for different strategies, including the frequency of follow-up testing. "What we learned was that the newer technologies such as liquid-based Pap testing and HPV (human papillomavirus ) testing add considerable cost but little to no benefit compared with conventional Pap smear follow-up," she said.

Among the options currently in use for women who have undergone treatment for CIN are conventional cervical cytology (Pap test) at six and 12 months followed by routine Pap testing if these tests are negative. Some patients are given colposcopy (an examination of the cervix using a magnifying lens) followed by an annual Pap test. Increasingly, physicians conduct the cytology with a liquid-based technique that is very popular but also more expensive than the conventional method; others also utilize a test for the presence of HPV, a sexually-transmitted infection linked to a majority of cervical cancers.

"Follow-up surveillance strategies must strike a balance between the detection and treatment of persistent or incident lesions and the overuse of costly and invasive diagnostic procedures and tests," the study authors write.

To evaluate the various strategies, Melnikow and her co-authors developed a computer model and applied available data from prior studies on CIN, including on the disease stages, treatment modalities, outcomes and follow-up strategies.

One of those studies, conducted by Melnikow and published in May 2009 in the Journal of the National Cancer Institute, found that risk of subsequent CIN or cervical cancer was associated with the type of treatment the women received, their age and the initial level of CIN diagnosed. Women who had been treated for CIN 3 with cryotherapy (a freezing method) were at higher risk for recurrence of the disease or invasive cancer.

In the new study, Melnikow and her colleagues found that the least expensive follow-up strategy was not the most effective in terms of patient outcomes. Conventional cytology at six and 12 months followed by cytology every three years was least expensive, but resulted in the largest number of subsequent cancers and cancer deaths. Although cytology conducted every year after initial treatment for CIN was more expensive, the strategy reduced expected cervical cancer deaths by 73 percent to 77 percent.

Researchers also found that for women who had a high risk of recurrence because of the stage of the CIN at diagnosis, colposcopy at six months after treatment followed by annual cytology was a cost-effective strategy. The study found that HPV testing and use of liquid-based cytology were more costly and did not improve life expectancy more than the less costly strategies.

"This tells us that surveillance can be tailored to a certain extent based on a woman's history and her risk of recurrence," Melnikow said. "More intensive surveillance is most important in women who are at higher risk of recurrence."


'/>"/>

Contact: Dorsey Griffith
dorsey.griffith@ucdmc.ucdavis.edu
916-734-9118
University of California -- Davis - Health System
Source:Eurekalert

Related medicine news :

1. Pet Dental Month Prime Time To Schedule Preventive Annual Cleaning For Pets
2. AAPC to Host 18th Annual National Conference in Nashville
3. Firmex Achieves 237% Annual Revenue Growth Despite Tough M&A Environment in 2009
4. MIT's Center for Transportation & Logistics Announces new Environmental Performance Consortium at Annual Crossroads Conference
5. Tyco International to Host 2010 Annual General Meeting of Shareholders
6. Heska Announces Q4 and Annual 2009 Results
7. Aflac Incorporated to Present at the 35th Annual Association of Insurance and Financial Analysts (AIFA) Conference
8. The 32nd Annual Los Angeles Chinatown Firecracker 5K/10K Run, Bike Ride, and Nite N Day Festival Celebrates the Year of the Tiger This Weekend
9. Restaurants, C-Stores and Retailers Defy the Challenging Economy Raising A Record $5.6 Million During Annual St. Jude Halloween Promotion
10. NIAID media tip sheet: Annual Meeting of the American Academy of Allergy, Asthma and Immunology
11. National Patient Advocate Foundation Delivers Constituent Cases to White House Health Summit Participants to Urge Elimination of Pre-Existing Conditions, Annual/Lifetime Limits and Capping Out-of-Pocket Expenses
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/24/2017)... ... 2017 , ... In the Health Care IT campaign, Robert Herjavec discusses health ... if you will be attacked, but when.” However, he and many others involved highlight ... , Improvements in auditing and monitoring have taken security in health care a very ...
(Date:2/24/2017)... ... ... The narrative in “ Signal 8: An Australian Paramedic’s Story ” (published by ... Schanssema describes the tragedies he saw, as well as his struggles with grief and ... unsure of the career path he wanted to take, found fulfillment in a career ...
(Date:2/24/2017)... ... February 24, 2017 , ... Yisrayl Hawkins, Pastor and Overseer ... Prophecy concerning this present generation. Yisrayl makes an astounding statement when he says ... He explains that the Bible details the current times so plainly that anyone should ...
(Date:2/24/2017)... ... February 24, 2017 , ... The Radiology Business Management ... radiology marketing programs at the annual Building Better Radiology Marketing Programs conference, ... Hotel in Fort Worth, Texas. Nine awards are given out in five categories. They ...
(Date:2/24/2017)... ... 2017 , ... Castle Farms, the celebrated Northern Michigan ... the winning couple announced on Feb. 14, 2017, on Facebook. The free wedding ... A Matter of Taste, Ryan Rousseau Enterprises, A Touch of Spring and Other ...
Breaking Medicine News(10 mins):
(Date:2/24/2017)... , Feb. 24, 2017  Xynomic Pharmaceuticals, Inc., ... announced that it has acquired exclusive worldwide rights ... best-in-class innovative HDAC inhibitor targeting hematological and solid ... 14 Phase 1 and 2 clinical trials of ... have already been completed, demonstrating that ...
(Date:2/23/2017)... SEOUL , Südkorea, 23. Februar 2017 ... LED für Sterilisationsaufgaben vorgestellt. Die Sterilisationsleistung beträgt das 1,5-fache ... kurzwellige ultraviolette Strahlung im Bereich zwischen 200 und 280 nm ... Ausbreitung von Bakterien, indem es ihre DNA zerstört. Das ... 280 nm. ...
(Date:2/23/2017)... , 23. Februar 2017 Im Rahmen ... eine nationale Wirtschaftszone in der südwestlichen chinesischen Provinz Guizhou, 2017 ... Errichtung einer Innovationsplattform aktiv an der Entwicklung einer eingebetteten Hightech-Schlüsselindustrie. ... Continue Reading ... ...
Breaking Medicine Technology: