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Re: New Pap Screening TechnologyFrom: Joanne Bulley (jbulley@cheshire.net)Wed Oct 29 23:41:39 1997
> >Date: Wed, 29 Oct 1997 06:47:28 -0600 (CST) >From: wfevans@worldnet.att.net (Walter Evans MD) writes:
>I would like to solicit the group's thoughts on new Pap
>------------------------------ In discussing this with our pathologist it seems a lot depends on your cyto techs and pathologists. From intense scrutiny and QI our False Negative rate is < 5%. The Computerized readings and the ThinPrep reduce this by probably 50%. (When used as usually recommended - as a rescreen of the negative PAPs - that is to about 2-3%.) The comparison however needs to be IF all Paps originally read as negative are rescreened byt the SAME technique (standard cytotech methods) the false negative rate is reduced by about the same # (according to our pathologist). The flip side is that about half of the PapNet and Autonet positives turn out to be false positives - so - to me the need is to be sure to educate ourselves and talk with our path team to find how they run their QI and what the institution's false positive and false negative rates etc are and discuss with your local colleagues to develope a group consensus. Some of you treat primarily upper income women who want to jump on ANY thing that comes up - whether it is just a gimmick or really helpful - that MAY help 'early' detection due to the cancer fear the ads so artfully play to. These people are generally very willing to pay the $40-60 for the added technology. The cost per life saved by the screening technique is *about* $3500 with pap smears. It is apparently estimated at $45000 with the PapNet or AutoPap screening of all negative paps. To quote Dr. George Morley of UMich - "A difference to be a difference must MAKE a difference" So - needless to say - when my patients ask I try to educate them on the issues and them let them make the decision. I have yet to find someone who wants one once I discuss this with them and they understand the faith (for want of a better word) and respect and communication I have with the path department. The Thin Prep system also washes out most of the other stuff. this is "good" for looking for squamous changes but reduces some of the other stuff we occasionally pick up. I have had a woman at low risk of Endometrial Cancer - thin, no HTN, no DM etc - whose Ca was identifed by the glandular cells on the pap suspicious of endometrial Ca. She had had a fairly benign climacteric - normal cycles til they quit - and no postmenopausal bleeding.
-- Joanne Bulley MD Keene, NH
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