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Liquid-Based Cytology vs Conventional Cytology in Detecting Cervical Cancer

Liquid-Based Cytology vs Conventional Cytology in Detecting Cervical Cancer To the Editor: Drs Schiffman and Solomon1 wrote an Editorial to accompany the randomized controlled trial by Siebers and colleagues,2 which found that liquid-based cytology did not perform better than conventional cytology. The Editorial stated that these findings are “unlikely to have a major effect on cytology screening methods in the United States.” The implication that current practices will not change (ie, that liquid-based cytology will generally be the exclusive method used) is important for resource-limited programs such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC). Since 1991, this program has served more than 3.4 million low-income, uninsured, or underinsured women (reaching 8.7% of the eligible population), provided more than 8 million screening examinations, and diagnosed 52 803 high-grade cervical precancers and 2382 invasive cervical cancers.3 Since 2005, the program has reimbursed for both cytology screening methods. However, the decision to reimburse for higher-cost liquid-based cytology (cost difference of around $15) was strongly influenced by the high market penetration in the use of liquid-based cytology with fewer program clinicians offering conventional cytology, not because liquid-based cytology is a superior method. Currently, 26% of NBCCEDP programs use conventional cytology while national surveys report that 15% of primary care clinicians still use conventional cytology.4 Often these clinicians are the ones seeing women who have lower incomes and participate in the NBCCEDP.5 The findings of the study by Siebers et al validated the practices of the clinicians and laboratories that have continued to use conventional cytology, whether in the NBCCEDP or in other programs for underserved women. Back to top Article Information Financial Disclosures: None reported. References 1. Schiffman M, Solomon D. Screening and prevention methods for cervical cancer. JAMA. 2009;302(16):1809-181019861676PubMedGoogle ScholarCrossref 2. Siebers AG, Klinkhamer PJ, Grefte JM, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA. 2009;302(16):1757-176419861667PubMedGoogle ScholarCrossref 3. National Breast and Cervical Cancer Early Detection Program. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/cancer/nbccedp/about.htm. Accessed December 30, 2009 4. Yabroff KR, Saraiya M, Meissner HI, et al. Specialty differences in primary care physician reports of Papanicolaou test screening practices: a national survey, 2006 to 2007. Ann Intern Med. 2009;151(9):602-61119884621PubMedGoogle ScholarCrossref 5. Saraiya M, Irwin KL, Carlin L, et al. Cervical cancer screening and management practices among providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Cancer. 2007;110(5):1024-103217628488PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Liquid-Based Cytology vs Conventional Cytology in Detecting Cervical Cancer

JAMA , Volume 303 (11) – Mar 17, 2010

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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.277
Publisher site
See Article on Publisher Site

Abstract

To the Editor: Drs Schiffman and Solomon1 wrote an Editorial to accompany the randomized controlled trial by Siebers and colleagues,2 which found that liquid-based cytology did not perform better than conventional cytology. The Editorial stated that these findings are “unlikely to have a major effect on cytology screening methods in the United States.” The implication that current practices will not change (ie, that liquid-based cytology will generally be the exclusive method used) is important for resource-limited programs such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC). Since 1991, this program has served more than 3.4 million low-income, uninsured, or underinsured women (reaching 8.7% of the eligible population), provided more than 8 million screening examinations, and diagnosed 52 803 high-grade cervical precancers and 2382 invasive cervical cancers.3 Since 2005, the program has reimbursed for both cytology screening methods. However, the decision to reimburse for higher-cost liquid-based cytology (cost difference of around $15) was strongly influenced by the high market penetration in the use of liquid-based cytology with fewer program clinicians offering conventional cytology, not because liquid-based cytology is a superior method. Currently, 26% of NBCCEDP programs use conventional cytology while national surveys report that 15% of primary care clinicians still use conventional cytology.4 Often these clinicians are the ones seeing women who have lower incomes and participate in the NBCCEDP.5 The findings of the study by Siebers et al validated the practices of the clinicians and laboratories that have continued to use conventional cytology, whether in the NBCCEDP or in other programs for underserved women. Back to top Article Information Financial Disclosures: None reported. References 1. Schiffman M, Solomon D. Screening and prevention methods for cervical cancer. JAMA. 2009;302(16):1809-181019861676PubMedGoogle ScholarCrossref 2. Siebers AG, Klinkhamer PJ, Grefte JM, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA. 2009;302(16):1757-176419861667PubMedGoogle ScholarCrossref 3. National Breast and Cervical Cancer Early Detection Program. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/cancer/nbccedp/about.htm. Accessed December 30, 2009 4. Yabroff KR, Saraiya M, Meissner HI, et al. Specialty differences in primary care physician reports of Papanicolaou test screening practices: a national survey, 2006 to 2007. Ann Intern Med. 2009;151(9):602-61119884621PubMedGoogle ScholarCrossref 5. Saraiya M, Irwin KL, Carlin L, et al. Cervical cancer screening and management practices among providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Cancer. 2007;110(5):1024-103217628488PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Mar 17, 2010

References