Colposcopy as a primary screening test for cervical cancer.
OBJECTIVE
To evaluate the cost effectiveness of screening by colposcopy compared to conventional cytology.


METHODS
A prospective study was performed in the Florence District screening center on 3,000 consecutive women, self referring, who were examined by cytology and colposcopy in a blind fashion. Further assessment was based on cytologic report or on colposcopy-directed punch biopsy. Actual costs of the whole screening process were known. The cost effectiveness of different possible simulated screening scenarios was then determined.


RESULTS
Overall, 18 high-grade lesions (CIN3 = 9, CIN2 = 9) were detected. Four different screening scenarios were compared, namely a) cytology alone, b) cytology + repeat smear for ASCUS (atypical squamous cells of undeterminate significance) cases, c) colposcopy + cytology for cases of condyloma at punch biopsy, and d) colposcopy alone. Although they had a higher cost per examined woman (a) = 17.98, b) = 19.40, c) = 23.86, d) = 22.10 US$), scenarios c) and d) had a higher relative sensitivity (a = 44.4, b = 61.1, c = 100, d = 88.8%) and a lower cost per high-grade lesion detected (a = 6,743, b = 5,291, c = 3,977, d = 4,144 US$).


CONCLUSIONS
Screening by colposcopy is a feasible procedure which is more sensitive and more cost effective than conventional cytology screening. At least in those settings where access to cytopathology may be difficult, screening by colposcopy should be considered as a possible alternative.
Cecchini
S
S
Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
Bonardi
R
R
Iossa
A
A
Zappa
M
M
Ciatto
S
S
D000328:Adult; D003127:Colposcopy / Q000191:economics; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology / Q000517:prevention & control*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000517:prevention & control