THE PAPANICOLAOU SMEAR - ITS VALUE AND LIMITATIONS

Authors
Citation
D. Lieu, THE PAPANICOLAOU SMEAR - ITS VALUE AND LIMITATIONS, Journal of family practice, 42(4), 1996, pp. 391-399
Citations number
40
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
00943509
Volume
42
Issue
4
Year of publication
1996
Pages
391 - 399
Database
ISI
SICI code
0094-3509(1996)42:4<391:TPS-IV>2.0.ZU;2-A
Abstract
Although the Papanicolaou (PaF) smear is one of the most effective scr eening tests ever invented for a common cancer, it remains an imperfec t test. The technical shortcomings of the Pap smear have been compound ed by the general public's unrealistically high expectations of the te st's accuracy, underestimations of the importance of regular smears, a nd the actions within the medico-legal system. To remedy some of the t echnical shortcomings, the Bethesda System, which better reflects our current knowledge about cervical neoplasia, has been proposed to repla ce the old Papanicolaou classification system. Although standardized c ytologic criteria may reduce interobserver variability, the false-nega tive rate of Pap smears is at least 5%, even in the best laboratories. No amount of training or experience with human observers can reduce t he error rate to zero. Automated Pap screening holds the promise of hi gher sensitivity, but no instruments to date have been approved as a s ole means of primary screening. The family physician can play a unique role in overcoming the limitations of the Pap smear by educating pati ents about the value and limitations of the test, instituting patient- specific treatment or follow-up of abnormal smears based on clinical a nd cytologic findings, and encouraging patients to get regular smears at intervals based on risk.