Ce. Wilkinson et al., PROSPECTIVE EVALUATION OF A RISK SCORING SYSTEM FOR CERVICAL NEOPLASIA IN PRIMARY-CARE, British journal of general practice, 44(385), 1994, pp. 341-344
Background. Against a background of concern over the costs of the cerv
ical screening programme in the United Kingdom, increased precision in
targeting groups at high risk of having an abnormal cervical smear of
fers a means of increasing efficiency. Previous papers have described
the development of a risk scoring system and its feasibility and relia
bility in primary care. Aim. A study was carried out to assess the val
idity of the scoring system by testing its predictive ability on a pro
spective data set. Method. Consecutive attenders for cervical smear te
sts at seven practices and three clinics were recruited for the study.
The women completed a questionnaire from which their risk scores coul
d be calculated The scores were compared with cytology and histology r
esults. Various performance statistics were obtained. Results. In term
s of cervical intraepithelial neoplasia (CIN) 2 or 3, there was an 11
fold increased risk among the low risk group (scores of four or five)
compared with the very low risk group (scores of three or less). The s
ystem enabled the identification of 75% (95% confidence interval 62% t
o 84%) of cases of CIN 2 or 3 among the 21% of the 3629 women with kno
wn histology who had a score of four or five. Conclusion. Given the ea
se with which risk status can be ascertained (a risk score could not b
e calculated for only 23 of 3661 women) and the magnitude of differenc
e in risk, the risk scoring system appears to have potential for assis
ting the targeting of screening resources. Studies of risk perception
and behaviour, and ultimately a randomized controlled trial, are requi
red to assess the effectiveness and cost effectiveness of risk targeti
ng.