Preventive Pap-smears: balancing costs, risks and benefits.
The pattern of spontaneous screening for cervical cancer by general practitioners and gynaecologists in The Netherlands is compared with an efficient screening policy resulting from a cost-effective study. Spontaneous screening tends to start and stop too early in a woman's life, and leaves too many women overscreened or unprotected. The combination in young age of a low incidence of invasive cancer and a high incidence of regressive lesions explains relative ineffectiveness and harmfulness of present screening practice. When screening would take place between ages 30 and at least 60, with intervals of about 5 years, as many lives could be saved for half the costs and with only 60% of the unnecessary referrals and treatments. Much attention should be paid to the coverage of the target population. Therapeutic follow-up policies for dysplastic lesions should be restrained.
van Ballegooijen
M
M
Department of Public Health and Social Medicine, Erasmus University Rotterdam, The Netherlands.
Habbema
J D
JD
van Oortmarssen
G J
GJ
Koopmanschap
M A
MA
Lubbe
J T
JT
van Agt
H M
HM
D000367:Age Factors; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065006:Papanicolaou Test; D012044:Regression Analysis; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000191:economics*